|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$5,640.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$630.86 |
| Max. Negotiated Rate |
$4,794.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,102.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,360.31
|
| Rate for Payer: Blue Distinction Transplant |
$3,384.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,333.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,645.16
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cigna of CA HMO |
$3,609.60
|
| Rate for Payer: Cigna of CA PPO |
$4,173.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Dignity Health Media |
$4,794.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,256.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,256.00
|
| Rate for Payer: Galaxy Health WC |
$4,794.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,761.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.60
|
| Rate for Payer: Multiplan Commercial |
$4,512.00
|
| Rate for Payer: Networks By Design Commercial |
$3,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,384.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,384.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,794.00
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$5,295.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$626.51 |
| Max. Negotiated Rate |
$4,500.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,500.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,912.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,912.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,154.76
|
| Rate for Payer: Blue Distinction Transplant |
$3,177.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,129.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,483.36
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cigna of CA HMO |
$3,388.80
|
| Rate for Payer: Cigna of CA PPO |
$3,918.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,500.75
|
| Rate for Payer: Dignity Health Media |
$4,500.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,500.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,118.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,118.00
|
| Rate for Payer: Galaxy Health WC |
$4,500.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,177.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,971.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,531.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,270.80
|
| Rate for Payer: Multiplan Commercial |
$4,236.00
|
| Rate for Payer: Networks By Design Commercial |
$3,441.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,500.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,177.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,177.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,500.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,500.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,500.75
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$9,253.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,220.72 |
| Max. Negotiated Rate |
$7,865.05 |
| Rate for Payer: Cash Price |
$4,163.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,701.20
|
| Rate for Payer: Galaxy Health WC |
$7,865.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,551.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,171.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,525.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,220.72
|
| Rate for Payer: Multiplan Commercial |
$7,402.40
|
| Rate for Payer: Networks By Design Commercial |
$6,014.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,865.05
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$626.51 |
| Max. Negotiated Rate |
$4,181.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,181.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,705.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,705.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,930.74
|
| Rate for Payer: Blue Distinction Transplant |
$2,951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,907.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,307.01
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cigna of CA HMO |
$3,148.16
|
| Rate for Payer: Cigna of CA PPO |
$3,640.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,181.15
|
| Rate for Payer: Dignity Health Media |
$4,181.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,181.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,967.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,967.60
|
| Rate for Payer: Galaxy Health WC |
$4,181.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,951.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,689.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,280.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.56
|
| Rate for Payer: Multiplan Commercial |
$3,935.20
|
| Rate for Payer: Networks By Design Commercial |
$3,197.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,181.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,951.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,951.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,181.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,181.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,181.15
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$8,411.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,018.64 |
| Max. Negotiated Rate |
$7,149.35 |
| Rate for Payer: Cash Price |
$3,784.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,364.40
|
| Rate for Payer: Galaxy Health WC |
$7,149.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,046.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,610.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,204.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,018.64
|
| Rate for Payer: Multiplan Commercial |
$6,728.80
|
| Rate for Payer: Networks By Design Commercial |
$5,467.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,149.35
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
IP
|
$10,019.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,404.56 |
| Max. Negotiated Rate |
$8,516.15 |
| Rate for Payer: Cash Price |
$4,508.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,007.60
|
| Rate for Payer: Galaxy Health WC |
$8,516.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,011.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,682.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,817.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,404.56
|
| Rate for Payer: Multiplan Commercial |
$8,015.20
|
| Rate for Payer: Networks By Design Commercial |
$6,512.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,516.15
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$626.51 |
| Max. Negotiated Rate |
$4,743.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,743.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,069.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,069.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,324.56
|
| Rate for Payer: Blue Distinction Transplant |
$3,348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,297.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,617.02
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cigna of CA HMO |
$3,571.20
|
| Rate for Payer: Cigna of CA PPO |
$4,129.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,743.00
|
| Rate for Payer: Dignity Health Media |
$4,743.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,743.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,232.00
|
| Rate for Payer: Galaxy Health WC |
$4,743.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,348.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,721.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.20
|
| Rate for Payer: Multiplan Commercial |
$4,464.00
|
| Rate for Payer: Networks By Design Commercial |
$3,627.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,743.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,743.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,743.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,743.00
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$7,616.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,827.84 |
| Max. Negotiated Rate |
$6,473.60 |
| Rate for Payer: Cash Price |
$3,427.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,046.40
|
| Rate for Payer: Galaxy Health WC |
$6,473.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,569.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,079.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,901.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,827.84
|
| Rate for Payer: Multiplan Commercial |
$6,092.80
|
| Rate for Payer: Networks By Design Commercial |
$4,950.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,473.60
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$627.10 |
| Max. Negotiated Rate |
$3,762.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,434.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,434.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,637.01
|
| Rate for Payer: Blue Distinction Transplant |
$2,655.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,615.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,075.79
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cigna of CA HMO |
$2,832.64
|
| Rate for Payer: Cigna of CA PPO |
$3,275.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Dignity Health Media |
$3,762.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,762.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,770.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,770.40
|
| Rate for Payer: Galaxy Health WC |
$3,762.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,655.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,319.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,952.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.24
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: Networks By Design Commercial |
$2,876.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,762.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,655.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,655.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,762.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,762.10
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$6,924.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,661.76 |
| Max. Negotiated Rate |
$5,885.40 |
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,769.60
|
| Rate for Payer: Galaxy Health WC |
$5,885.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,154.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,618.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,638.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,661.76
|
| Rate for Payer: Multiplan Commercial |
$5,539.20
|
| Rate for Payer: Networks By Design Commercial |
$4,500.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,885.40
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$627.10 |
| Max. Negotiated Rate |
$3,440.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,226.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,411.80
|
| Rate for Payer: Blue Distinction Transplant |
$2,428.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,392.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,898.51
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cigna of CA HMO |
$2,590.72
|
| Rate for Payer: Cigna of CA PPO |
$2,995.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Media |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,036.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.52
|
| Rate for Payer: Multiplan Commercial |
$3,238.40
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
IP
|
$9,035.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,168.40 |
| Max. Negotiated Rate |
$7,679.75 |
| Rate for Payer: Cash Price |
$4,065.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,614.00
|
| Rate for Payer: Galaxy Health WC |
$7,679.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,421.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,026.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,442.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,168.40
|
| Rate for Payer: Multiplan Commercial |
$7,228.00
|
| Rate for Payer: Networks By Design Commercial |
$5,872.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,679.75
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
OP
|
$4,803.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$627.10 |
| Max. Negotiated Rate |
$4,082.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,082.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,641.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,641.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,861.63
|
| Rate for Payer: Blue Distinction Transplant |
$2,881.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,252.61
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Cigna of CA HMO |
$3,073.92
|
| Rate for Payer: Cigna of CA PPO |
$3,554.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,082.55
|
| Rate for Payer: Dignity Health Media |
$4,082.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,082.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,921.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,921.20
|
| Rate for Payer: Galaxy Health WC |
$4,082.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,881.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,602.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,203.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.72
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: Networks By Design Commercial |
$3,121.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,082.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,881.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,881.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,082.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,082.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,082.55
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
OP
|
$3,101.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,705.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,705.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,847.58
|
| Rate for Payer: Blue Distinction Transplant |
$1,860.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,832.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,454.37
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cigna of CA HMO |
$1,984.64
|
| Rate for Payer: Cigna of CA PPO |
$2,294.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Media |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,325.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.24
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.85
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,336.80 |
| Max. Negotiated Rate |
$4,734.50 |
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.00
|
| Rate for Payer: Galaxy Health WC |
$4,734.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,122.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Multiplan Commercial |
$4,456.00
|
| Rate for Payer: Networks By Design Commercial |
$3,620.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,734.50
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
IP
|
$5,305.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,273.20 |
| Max. Negotiated Rate |
$4,509.25 |
| Rate for Payer: Cash Price |
$2,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,122.00
|
| Rate for Payer: Galaxy Health WC |
$4,509.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,538.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,021.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,273.20
|
| Rate for Payer: Multiplan Commercial |
$4,244.00
|
| Rate for Payer: Networks By Design Commercial |
$3,448.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,509.25
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,498.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,623.56
|
| Rate for Payer: Blue Distinction Transplant |
$1,635.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,610.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,278.02
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cigna of CA HMO |
$1,744.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Media |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,090.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,090.00
|
| Rate for Payer: Galaxy Health WC |
$2,316.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,635.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,043.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,817.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.00
|
| Rate for Payer: Multiplan Commercial |
$2,180.00
|
| Rate for Payer: Networks By Design Commercial |
$1,771.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,316.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,635.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,635.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,316.25
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,073.38
|
| Rate for Payer: Blue Distinction Transplant |
$2,088.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,632.12
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO |
$2,227.20
|
| Rate for Payer: Cigna of CA PPO |
$2,575.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Media |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,392.00
|
| Rate for Payer: Galaxy Health WC |
$2,958.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,610.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.20
|
| Rate for Payer: Multiplan Commercial |
$2,784.00
|
| Rate for Payer: Networks By Design Commercial |
$2,262.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,073.38
|
| Rate for Payer: Blue Distinction Transplant |
$2,088.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,632.12
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO |
$2,227.20
|
| Rate for Payer: Cigna of CA PPO |
$2,575.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Media |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,392.00
|
| Rate for Payer: Galaxy Health WC |
$2,958.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,610.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.20
|
| Rate for Payer: Multiplan Commercial |
$2,784.00
|
| Rate for Payer: Networks By Design Commercial |
$2,262.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$5,849.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,403.76 |
| Max. Negotiated Rate |
$4,971.65 |
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,339.60
|
| Rate for Payer: Galaxy Health WC |
$4,971.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,509.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,901.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,228.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.76
|
| Rate for Payer: Multiplan Commercial |
$4,679.20
|
| Rate for Payer: Networks By Design Commercial |
$3,801.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,971.65
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$5,849.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,403.76 |
| Max. Negotiated Rate |
$4,971.65 |
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,339.60
|
| Rate for Payer: Galaxy Health WC |
$4,971.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,509.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,901.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,228.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.76
|
| Rate for Payer: Multiplan Commercial |
$4,679.20
|
| Rate for Payer: Networks By Design Commercial |
$3,801.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,971.65
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
IP
|
$3,810.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$914.40 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.00
|
| Rate for Payer: Galaxy Health WC |
$3,238.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,541.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,451.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.40
|
| Rate for Payer: Multiplan Commercial |
$3,048.00
|
| Rate for Payer: Networks By Design Commercial |
$2,476.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,238.50
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
OP
|
$2,228.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$534.72 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,225.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,225.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,336.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,316.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,044.93
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cigna of CA HMO |
$1,425.92
|
| Rate for Payer: Cigna of CA PPO |
$1,648.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Dignity Health Media |
$1,893.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,893.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$891.20
|
| Rate for Payer: Galaxy Health WC |
$1,893.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.72
|
| Rate for Payer: Multiplan Commercial |
$1,782.40
|
| Rate for Payer: Networks By Design Commercial |
$1,448.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,893.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,336.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,168.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,168.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1,168.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,168.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,893.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,893.80
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
OP
|
$2,001.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$480.24 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,100.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,192.20
|
| Rate for Payer: Blue Distinction Transplant |
$1,200.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.59
|
| Rate for Payer: Blue Shield of California EPN |
$938.47
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cigna of CA HMO |
$1,280.64
|
| Rate for Payer: Cigna of CA PPO |
$1,480.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Dignity Health Media |
$1,700.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,700.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,500.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,200.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,200.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,124.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1,124.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,124.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,124.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,700.85
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
IP
|
$3,423.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$821.52 |
| Max. Negotiated Rate |
$2,909.55 |
| Rate for Payer: Cash Price |
$1,540.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,369.20
|
| Rate for Payer: Galaxy Health WC |
$2,909.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,053.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,304.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.52
|
| Rate for Payer: Multiplan Commercial |
$2,738.40
|
| Rate for Payer: Networks By Design Commercial |
$2,224.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,909.55
|
|
