|
HC ANTI REFLUX VALVE SALEM SUMP
|
Facility
|
OP
|
$12.22
|
|
| Hospital Charge Code |
901698823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$7.82
|
| Rate for Payer: Cigna of CA PPO |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.55
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO |
$6.11
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.39
|
| Rate for Payer: Vantage Medical Group Senior |
$10.39
|
|
|
HC ANTI REFLUX VALVE SALEM SUMP
|
Facility
|
IP
|
$12.22
|
|
| Hospital Charge Code |
901698823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
OP
|
$74.97
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$134.46 |
| Rate for Payer: Adventist Health Commercial |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.46
|
| Rate for Payer: Blue Shield of California Commercial |
$50.15
|
| Rate for Payer: Blue Shield of California EPN |
$33.14
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cigna of CA HMO |
$47.98
|
| Rate for Payer: Cigna of CA PPO |
$55.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$63.72
|
| Rate for Payer: Global Benefits Group Commercial |
$44.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$59.98
|
| Rate for Payer: Networks By Design Commercial |
$48.73
|
| Rate for Payer: Prime Health Services Commercial |
$63.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11.85
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$138.55 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.12
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$106.79 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.79
|
| Rate for Payer: Blue Shield of California Commercial |
$68.24
|
| Rate for Payer: Blue Shield of California EPN |
$45.08
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO |
$65.28
|
| Rate for Payer: Cigna of CA PPO |
$75.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.59
|
| Rate for Payer: EPIC Health Plan Senior |
$10.81
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.49
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.85
|
| Rate for Payer: Blue Shield of California Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California EPN |
$25.64
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.85
|
| Rate for Payer: Blue Shield of California Commercial |
$79.61
|
| Rate for Payer: Blue Shield of California EPN |
$52.60
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,383.80 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$620.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Multiplan Commercial |
$1,302.40
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$481.60
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$458.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$745.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.19 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$895.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.92
|
| Rate for Payer: Cigna of CA PPO |
$1,204.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,383.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,139.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.60
|
| Rate for Payer: Multiplan Commercial |
$1,302.40
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.80
|
| 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 |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,383.80
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,023.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$662.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$903.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna of CA HMO |
$770.56
|
| Rate for Payer: Cigna of CA PPO |
$890.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,023.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,023.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$481.60
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$745.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$842.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$842.80
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.40
|
| 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 |
$1,023.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,023.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,023.40
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.58 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$494.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,102.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,360.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,854.75
|
| 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 |
$1,112.85
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: Cigna of CA HMO |
$1,607.45
|
| Rate for Payer: Cigna of CA PPO |
$1,830.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,102.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,102.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,102.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$989.20
|
| Rate for Payer: EPIC Health Plan Senior |
$989.20
|
| Rate for Payer: Galaxy Health WC |
$2,102.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,483.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,649.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,530.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,731.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,731.10
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Networks By Design Commercial |
$1,607.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,102.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,483.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,483.80
|
| 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 |
$2,102.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,102.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,102.05
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$2,043.40 |
| Rate for Payer: Adventist Health Commercial |
$480.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$915.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.96
|
| Rate for Payer: Multiplan Commercial |
$1,923.20
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$494.60 |
| Max. Negotiated Rate |
$2,102.05 |
| Rate for Payer: Adventist Health Commercial |
$494.60
|
| Rate for Payer: Cash Price |
$1,112.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$989.20
|
| Rate for Payer: EPIC Health Plan Senior |
$989.20
|
| Rate for Payer: Galaxy Health WC |
$2,102.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,483.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,649.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$942.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,530.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.52
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Networks By Design Commercial |
$1,607.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,102.05
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.58 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$480.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,322.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,803.00
|
| 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 |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna of CA HMO |
$1,562.60
|
| Rate for Payer: Cigna of CA PPO |
$1,778.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,043.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,043.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,682.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,682.80
|
| Rate for Payer: Multiplan Commercial |
$1,923.20
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,442.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,442.40
|
| 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 |
$2,043.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,043.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,043.40
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$11,040.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Adventist Health Commercial |
$2,208.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,241.14
|
| 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 |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,756.48
|
| Rate for Payer: Blue Shield of California EPN |
$4,460.16
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: Cigna of CA HMO |
$7,065.60
|
| Rate for Payer: Cigna of CA PPO |
$8,169.60
|
| 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 |
$9,384.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,624.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,363.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,649.60
|
| 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 |
$8,832.00
|
| Rate for Payer: Networks By Design Commercial |
$7,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,384.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,624.00
|
| 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 AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$14,936.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,987.20 |
| Max. Negotiated Rate |
$12,695.60 |
| Rate for Payer: Adventist Health Commercial |
$2,987.20
|
| Rate for Payer: Cash Price |
$6,721.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,974.40
|
| Rate for Payer: Galaxy Health WC |
$12,695.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,961.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,962.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,690.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,245.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,584.64
|
| Rate for Payer: Multiplan Commercial |
$11,948.80
|
| Rate for Payer: Networks By Design Commercial |
$9,708.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,695.60
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$11,040.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,208.00 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Adventist Health Commercial |
$2,208.00
|
| Rate for Payer: Cash Price |
$4,968.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,416.00
|
| Rate for Payer: Galaxy Health WC |
$9,384.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,624.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,363.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,206.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,833.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,649.60
|
| Rate for Payer: Multiplan Commercial |
$8,832.00
|
| Rate for Payer: Networks By Design Commercial |
$7,176.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,384.00
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$14,936.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$12,695.60 |
| Rate for Payer: Adventist Health Commercial |
$2,987.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,796.52
|
| 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 |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9,140.83
|
| Rate for Payer: Blue Shield of California EPN |
$6,034.14
|
| Rate for Payer: Cash Price |
$6,721.20
|
| Rate for Payer: Cash Price |
$6,721.20
|
| Rate for Payer: Cigna of CA HMO |
$9,559.04
|
| Rate for Payer: Cigna of CA PPO |
$11,052.64
|
| 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 |
$12,695.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,961.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,962.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,584.64
|
| 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 |
$11,948.80
|
| Rate for Payer: Networks By Design Commercial |
$9,708.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,695.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,961.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,961.60
|
| 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 AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$12,186.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,437.20 |
| Max. Negotiated Rate |
$10,358.10 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,874.40
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,642.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,543.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.64
|
| Rate for Payer: Multiplan Commercial |
$9,748.80
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
|
