|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,314.20 |
| Max. Negotiated Rate |
$5,585.35 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.40
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,067.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$8,891.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,778.20 |
| Max. Negotiated Rate |
$7,557.35 |
| Rate for Payer: Adventist Health Commercial |
$1,778.20
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,556.40
|
| Rate for Payer: Galaxy Health WC |
$7,557.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,334.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,930.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,387.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,503.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,133.84
|
| Rate for Payer: Multiplan Commercial |
$7,112.80
|
| Rate for Payer: Networks By Design Commercial |
$5,779.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,557.35
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$8,891.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$199.97 |
| Max. Negotiated Rate |
$7,557.35 |
| Rate for Payer: Adventist Health Commercial |
$1,778.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,831.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,441.29
|
| Rate for Payer: Blue Shield of California EPN |
$3,591.96
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Cigna of CA HMO |
$5,690.24
|
| Rate for Payer: Cigna of CA PPO |
$6,579.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$7,557.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,334.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,930.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,133.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,112.80
|
| Rate for Payer: Networks By Design Commercial |
$5,779.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,557.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,334.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,334.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$199.97 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,309.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,021.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,654.68
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cigna of CA HMO |
$4,205.44
|
| Rate for Payer: Cigna of CA PPO |
$4,862.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$199.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$10,156.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,661.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.85
|
| Rate for Payer: Blue Shield of California Commercial |
$6,215.47
|
| Rate for Payer: Blue Shield of California EPN |
$4,103.02
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cigna of CA HMO |
$6,499.84
|
| Rate for Payer: Cigna of CA PPO |
$7,515.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,093.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,093.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$10,156.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,031.20 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,062.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,062.40
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,869.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,286.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
OP
|
$13,787.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$355.08 |
| Max. Negotiated Rate |
$11,718.95 |
| Rate for Payer: Adventist Health Commercial |
$2,757.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,042.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8,437.64
|
| Rate for Payer: Blue Shield of California EPN |
$5,569.95
|
| Rate for Payer: Cash Price |
$6,204.15
|
| Rate for Payer: Cash Price |
$6,204.15
|
| Rate for Payer: Cigna of CA HMO |
$8,823.68
|
| Rate for Payer: Cigna of CA PPO |
$10,202.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$11,718.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,272.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,195.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,308.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$11,029.60
|
| Rate for Payer: Networks By Design Commercial |
$8,961.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,718.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,272.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,272.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
IP
|
$13,787.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,757.40 |
| Max. Negotiated Rate |
$11,718.95 |
| Rate for Payer: Adventist Health Commercial |
$2,757.40
|
| Rate for Payer: Cash Price |
$6,204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,514.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,514.80
|
| Rate for Payer: Galaxy Health WC |
$11,718.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,272.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,195.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,252.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,534.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,308.88
|
| Rate for Payer: Multiplan Commercial |
$11,029.60
|
| Rate for Payer: Networks By Design Commercial |
$8,961.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,718.95
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$16,217.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,243.40 |
| Max. Negotiated Rate |
$13,784.45 |
| Rate for Payer: Adventist Health Commercial |
$3,243.40
|
| Rate for Payer: Cash Price |
$7,297.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,486.80
|
| Rate for Payer: Galaxy Health WC |
$13,784.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,730.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,816.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,178.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,038.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,892.08
|
| Rate for Payer: Multiplan Commercial |
$12,973.60
|
| Rate for Payer: Networks By Design Commercial |
$10,541.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,784.45
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$11,987.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,397.40 |
| Max. Negotiated Rate |
$10,188.95 |
| Rate for Payer: Adventist Health Commercial |
$2,397.40
|
| Rate for Payer: Cash Price |
$5,394.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,794.80
|
| Rate for Payer: Galaxy Health WC |
$10,188.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,192.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,995.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,567.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,419.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,876.88
|
| Rate for Payer: Multiplan Commercial |
$9,589.60
|
| Rate for Payer: Networks By Design Commercial |
$7,791.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,188.95
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$16,217.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$218.84 |
| Max. Negotiated Rate |
$13,784.45 |
| Rate for Payer: Adventist Health Commercial |
$3,243.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,636.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9,924.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,551.67
|
| Rate for Payer: Cash Price |
$7,297.65
|
| Rate for Payer: Cash Price |
$7,297.65
|
| Rate for Payer: Cigna of CA HMO |
$10,378.88
|
| Rate for Payer: Cigna of CA PPO |
$12,000.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$13,784.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,730.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,816.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$12,973.60
|
| Rate for Payer: Networks By Design Commercial |
$10,541.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,784.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$11,987.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$218.84 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$2,397.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,862.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,336.04
|
| Rate for Payer: Blue Shield of California EPN |
$4,842.75
|
| Rate for Payer: Cash Price |
$5,394.15
|
| Rate for Payer: Cash Price |
$5,394.15
|
| Rate for Payer: Cigna of CA HMO |
$7,671.68
|
| Rate for Payer: Cigna of CA PPO |
$8,870.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$10,188.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,192.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,995.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,876.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$9,589.60
|
| Rate for Payer: Networks By Design Commercial |
$7,791.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,188.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,192.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,192.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPHY ARTERIOVENOUS SHNT
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
CPT 75791
|
| Hospital Charge Code |
909020048
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,703.00 |
| Rate for Payer: Adventist Health Commercial |
$636.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,085.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,703.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,749.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,385.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,952.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,946.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,284.72
|
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Cigna of CA HMO |
$2,035.20
|
| Rate for Payer: Cigna of CA PPO |
$2,353.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,703.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,703.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,703.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,272.00
|
| Rate for Payer: Galaxy Health WC |
$2,703.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,968.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,226.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,226.00
|
| Rate for Payer: Multiplan Commercial |
$2,544.00
|
| Rate for Payer: Networks By Design Commercial |
$2,067.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,703.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,908.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,908.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,590.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,590.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,590.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,590.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,703.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,703.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,703.00
|
|
|
HC ANGIOJET PUMP SET
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$557.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
HC ANGIOJET PUMP SET
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$590.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.69
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO |
$576.00
|
| Rate for Payer: Cigna of CA PPO |
$666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$557.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$630.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$938.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.56
|
| Rate for Payer: Blue Shield of California EPN |
$787.32
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna of CA HMO |
$2,058.00
|
| Rate for Payer: Cigna of CA PPO |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,103.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.85
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,702.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,169.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,428.84
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna of CA HMO |
$2,058.00
|
| Rate for Payer: Cigna of CA PPO |
$2,058.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,499.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,058.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,058.00
|
| Rate for Payer: Multiplan Commercial |
$2,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,103.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,499.00
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$781.92
|
| Rate for Payer: Blue Shield of California Commercial |
$996.30
|
| Rate for Payer: Blue Shield of California EPN |
$656.10
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,084.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$416.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,146.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,563.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cigna of CA HMO |
$1,354.60
|
| Rate for Payer: Cigna of CA PPO |
$1,542.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,771.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,771.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$833.60
|
| Rate for Payer: EPIC Health Plan Senior |
$833.60
|
| Rate for Payer: Galaxy Health WC |
$1,771.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,250.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,458.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,458.80
|
| Rate for Payer: Multiplan Commercial |
$1,667.20
|
| Rate for Payer: Networks By Design Commercial |
$1,354.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,771.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,250.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,250.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,771.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,771.40
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,823.25 |
| Rate for Payer: Adventist Health Commercial |
$429.00
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.00
|
| Rate for Payer: EPIC Health Plan Senior |
$858.00
|
| Rate for Payer: Galaxy Health WC |
$1,823.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,430.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$817.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,327.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.80
|
| Rate for Payer: Multiplan Commercial |
$1,716.00
|
| Rate for Payer: Networks By Design Commercial |
$1,394.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,823.25
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,823.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,179.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,608.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna of CA HMO |
$1,394.25
|
| Rate for Payer: Cigna of CA PPO |
$1,587.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,823.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,823.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,823.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.00
|
| Rate for Payer: EPIC Health Plan Senior |
$858.00
|
| Rate for Payer: Galaxy Health WC |
$1,823.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,430.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,327.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,501.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,716.00
|
| Rate for Payer: Networks By Design Commercial |
$1,394.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,823.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,287.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,287.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,823.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,823.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,823.25
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,084.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$416.80 |
| Max. Negotiated Rate |
$1,771.40 |
| Rate for Payer: Adventist Health Commercial |
$416.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$833.60
|
| Rate for Payer: EPIC Health Plan Senior |
$833.60
|
| Rate for Payer: Galaxy Health WC |
$1,771.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,250.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.16
|
| Rate for Payer: Multiplan Commercial |
$1,667.20
|
| Rate for Payer: Networks By Design Commercial |
$1,354.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,771.40
|
|
