|
HC VENOGRAM EPIDURAL
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$784.90 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,423.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.19
|
| Rate for Payer: BCBS Transplant Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,061.27
|
| Rate for Payer: Blue Shield of California EPN |
$5,603.61
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: IEHP Medi-Cal |
$1,271.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,867.52 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,552.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
IP
|
$5,973.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,433.52 |
| Max. Negotiated Rate |
$5,077.05 |
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,389.20
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,275.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,433.52
|
| Rate for Payer: Multiplan Commercial |
$4,778.40
|
| Rate for Payer: Networks By Design Commercial |
$3,882.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
OP
|
$5,973.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$5,077.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$646.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.45
|
| Rate for Payer: BCBS Transplant Transplant |
$3,583.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,530.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,801.34
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cigna of CA HMO |
$3,822.72
|
| Rate for Payer: Cigna of CA PPO |
$4,420.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,479.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: IEHP Medi-Cal |
$3,241.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,433.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,778.40
|
| Rate for Payer: Networks By Design Commercial |
$3,882.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,583.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,583.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,583.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$3,384.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$576.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.94
|
| Rate for Payer: BCBS Transplant Transplant |
$2,389.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,353.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.56
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Cigna of CA HMO |
$2,548.48
|
| Rate for Payer: Cigna of CA PPO |
$2,946.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,384.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,389.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,986.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: IEHP Medi-Cal |
$3,241.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$955.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,185.60
|
| Rate for Payer: Networks By Design Commercial |
$2,588.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,384.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,389.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,389.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,389.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$955.68 |
| Max. Negotiated Rate |
$3,384.70 |
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,592.80
|
| Rate for Payer: Galaxy Health WC |
$3,384.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,389.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,517.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$955.68
|
| Rate for Payer: Multiplan Commercial |
$3,185.60
|
| Rate for Payer: Networks By Design Commercial |
$2,588.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,384.70
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
OP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.69 |
| Max. Negotiated Rate |
$11,122.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$955.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.14
|
| Rate for Payer: BCBS Transplant Transplant |
$7,851.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,733.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,136.86
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Cigna of CA HMO |
$8,374.40
|
| Rate for Payer: Cigna of CA PPO |
$9,682.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,122.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,851.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,813.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,727.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,140.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,468.00
|
| Rate for Payer: Networks By Design Commercial |
$8,505.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,122.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,851.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,851.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,851.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
IP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,140.40 |
| Max. Negotiated Rate |
$11,122.25 |
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,234.00
|
| Rate for Payer: Galaxy Health WC |
$11,122.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,851.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,727.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,985.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,140.40
|
| Rate for Payer: Multiplan Commercial |
$10,468.00
|
| Rate for Payer: Networks By Design Commercial |
$8,505.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,122.25
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,867.52 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,552.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$988.05 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$988.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.19
|
| Rate for Payer: BCBS Transplant Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,061.27
|
| Rate for Payer: Blue Shield of California EPN |
$5,603.61
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM ORBITAL
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,867.52 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,552.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC VENOGRAM ORBITAL
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.94 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$866.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.94
|
| Rate for Payer: BCBS Transplant Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,061.27
|
| Rate for Payer: Blue Shield of California EPN |
$5,603.61
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: IEHP Medi-Cal |
$1,271.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
OP
|
$11,597.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,081.14 |
| Max. Negotiated Rate |
$9,857.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,081.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.19
|
| Rate for Payer: BCBS Transplant Transplant |
$6,958.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,853.83
|
| Rate for Payer: Blue Shield of California EPN |
$5,438.99
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cigna of CA HMO |
$7,422.08
|
| Rate for Payer: Cigna of CA PPO |
$8,581.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,697.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,783.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,277.60
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,958.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,958.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,958.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
IP
|
$11,597.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,783.28 |
| Max. Negotiated Rate |
$9,857.45 |
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,638.80
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,418.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,783.28
|
| Rate for Payer: Multiplan Commercial |
$9,277.60
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,855.44 |
| Max. Negotiated Rate |
$6,571.35 |
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.44
|
| Rate for Payer: Multiplan Commercial |
$6,184.80
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$977.27 |
| Max. Negotiated Rate |
$6,571.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$977.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,287.66
|
| Rate for Payer: BCBS Transplant Transplant |
$4,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,569.02
|
| Rate for Payer: Blue Shield of California EPN |
$3,625.84
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cigna of CA HMO |
$4,947.84
|
| Rate for Payer: Cigna of CA PPO |
$5,720.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,798.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,184.80
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,638.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
IP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,558.32 |
| Max. Negotiated Rate |
$5,519.05 |
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,597.20
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,473.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.32
|
| Rate for Payer: Multiplan Commercial |
$5,194.40
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
OP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.58 |
| Max. Negotiated Rate |
$5,519.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$975.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.14
|
| Rate for Payer: BCBS Transplant Transplant |
$3,895.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,837.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,045.22
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cigna of CA HMO |
$4,155.52
|
| Rate for Payer: Cigna of CA PPO |
$4,804.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,869.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: IEHP Medi-Cal |
$3,241.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$5,194.40
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,895.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,895.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$979.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.19
|
| Rate for Payer: BCBS Transplant Transplant |
$2,548.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,992.31
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna of CA HMO |
$2,718.72
|
| Rate for Payer: Cigna of CA PPO |
$3,143.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$3,610.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,548.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,186.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,833.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$3,398.40
|
| Rate for Payer: Networks By Design Commercial |
$2,761.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,610.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,548.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,548.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,548.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,019.52 |
| Max. Negotiated Rate |
$3,610.80 |
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.20
|
| Rate for Payer: Galaxy Health WC |
$3,610.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,548.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,833.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,618.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.52
|
| Rate for Payer: Multiplan Commercial |
$3,398.40
|
| Rate for Payer: Networks By Design Commercial |
$2,761.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,610.80
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
IP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
OP
|
$907.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$544.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: Dignity Health Media |
$770.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$680.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$544.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
IP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.16 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
OP
|
$559.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.16 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$307.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cigna of CA PPO |
$413.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.15
|
| Rate for Payer: Dignity Health Media |
$475.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$475.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$419.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$335.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.15
|
| Rate for Payer: Vantage Medical Group Senior |
$475.15
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
OP
|
$599.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$329.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$359.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Media |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$449.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$359.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
