|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Central Health Plan Commercial |
$116.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Senior |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$59.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.93
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Central Health Plan Commercial |
$116.80
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Senior |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.20
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Riverside University Health System MISP |
$58.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Central Health Plan Commercial |
$116.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Senior |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.93
|
| Rate for Payer: Blue Shield of California Commercial |
$91.98
|
| Rate for Payer: Blue Shield of California EPN |
$57.96
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Central Health Plan Commercial |
$116.80
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Senior |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$131.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$102.20
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Riverside University Health System MISP |
$58.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900510279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.65
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$29.61
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$18.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.34
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.90
|
| Rate for Payer: Riverside University Health System MISP |
$10.27
|
| Rate for Payer: Riverside University Health System MISP |
$10.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900510279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
906536415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.65
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$29.61
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$18.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.34
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.90
|
| Rate for Payer: Riverside University Health System MISP |
$10.27
|
| Rate for Payer: Riverside University Health System MISP |
$10.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
906536415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.65
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$29.61
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$18.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.34
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.90
|
| Rate for Payer: Riverside University Health System MISP |
$10.27
|
| Rate for Payer: Riverside University Health System MISP |
$10.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
IP
|
$11,336.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,267.20 |
| Max. Negotiated Rate |
$10,202.40 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Cash Price |
$5,101.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,068.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,935.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,534.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,534.40
|
| Rate for Payer: Galaxy Health WC |
$9,635.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,801.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,202.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,198.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,688.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
OP
|
$11,336.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,073.56 |
| Max. Negotiated Rate |
$10,202.40 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,073.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,635.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,234.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,502.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,141.68
|
| Rate for Payer: Blue Shield of California EPN |
$4,500.39
|
| Rate for Payer: Cash Price |
$5,101.20
|
| Rate for Payer: Cash Price |
$5,101.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,068.80
|
| Rate for Payer: Cigna of CA HMO |
$7,255.04
|
| Rate for Payer: Cigna of CA PPO |
$8,388.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,635.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,635.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,635.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,935.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,534.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,534.40
|
| Rate for Payer: Galaxy Health WC |
$9,635.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,801.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,202.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,198.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,114.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,688.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,935.20
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,801.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,801.60
|
| 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 |
$9,635.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,635.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9,635.60
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
IP
|
$7,557.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,511.40 |
| Max. Negotiated Rate |
$6,801.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.40
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,045.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,289.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,022.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,022.80
|
| Rate for Payer: Galaxy Health WC |
$6,423.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,801.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,798.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,458.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
OP
|
$7,557.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$956.80 |
| Max. Negotiated Rate |
$6,801.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$956.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,760.91
|
| Rate for Payer: Blue Shield of California EPN |
$3,000.13
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,045.60
|
| Rate for Payer: Cigna of CA HMO |
$4,836.48
|
| Rate for Payer: Cigna of CA PPO |
$5,592.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,289.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$6,423.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,801.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,798.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,534.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,534.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,890.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$806.82 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,421.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,357.77
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Cigna of CA HMO |
$7,474.56
|
| Rate for Payer: Cigna of CA PPO |
$8,642.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,007.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
OP
|
$5,839.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.37 |
| Max. Negotiated Rate |
$5,255.10 |
| Rate for Payer: Adventist Health Commercial |
$1,167.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,678.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,318.08
|
| Rate for Payer: Cash Price |
$2,627.55
|
| Rate for Payer: Cash Price |
$2,627.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,671.20
|
| Rate for Payer: Cigna of CA HMO |
$3,736.96
|
| Rate for Payer: Cigna of CA PPO |
$4,320.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,087.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,963.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,255.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,707.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,379.25
|
| Rate for Payer: Networks By Design Commercial |
$3,795.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Prime Health Services Commercial |
$4,963.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,503.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,503.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
IP
|
$5,839.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,167.80 |
| Max. Negotiated Rate |
$5,255.10 |
| Rate for Payer: Adventist Health Commercial |
$1,167.80
|
| Rate for Payer: Cash Price |
$2,627.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,671.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,087.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,335.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,335.60
|
| Rate for Payer: Galaxy Health WC |
$4,963.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,255.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,707.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,445.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.80
|
| Rate for Payer: Multiplan Commercial |
$4,379.25
|
| Rate for Payer: Networks By Design Commercial |
$3,795.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,963.15
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
IP
|
$3,892.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$778.40 |
| Max. Negotiated Rate |
$3,502.80 |
| Rate for Payer: Adventist Health Commercial |
$778.40
|
| Rate for Payer: Cash Price |
$1,751.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,113.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,724.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,556.80
|
| Rate for Payer: Galaxy Health WC |
$3,308.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,335.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,502.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,471.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,296.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.40
|
| Rate for Payer: Multiplan Commercial |
$2,919.00
|
| Rate for Payer: Networks By Design Commercial |
$2,529.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,308.20
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
OP
|
$3,892.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.13 |
| Max. Negotiated Rate |
$3,502.80 |
| Rate for Payer: Adventist Health Commercial |
$778.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$576.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,451.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,545.12
|
| Rate for Payer: Cash Price |
$1,751.40
|
| Rate for Payer: Cash Price |
$1,751.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,113.60
|
| Rate for Payer: Cigna of CA HMO |
$2,490.88
|
| Rate for Payer: Cigna of CA PPO |
$2,880.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,724.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$3,308.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,335.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,502.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,471.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,919.00
|
| Rate for Payer: Networks By Design Commercial |
$2,529.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Prime Health Services Commercial |
$3,308.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,335.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,335.20
|
| 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: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
IP
|
$12,791.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,558.20 |
| Max. Negotiated Rate |
$11,511.90 |
| Rate for Payer: Adventist Health Commercial |
$2,558.20
|
| Rate for Payer: Cash Price |
$5,755.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,232.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.40
|
| Rate for Payer: Galaxy Health WC |
$10,872.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,511.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,546.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.20
|
| Rate for Payer: Multiplan Commercial |
$9,593.25
|
| Rate for Payer: Networks By Design Commercial |
$8,314.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,872.35
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
OP
|
$12,791.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.05 |
| Max. Negotiated Rate |
$11,511.90 |
| Rate for Payer: Adventist Health Commercial |
$2,558.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$954.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.33
|
| Rate for Payer: Blue Shield of California EPN |
$5,078.03
|
| Rate for Payer: Cash Price |
$5,755.95
|
| Rate for Payer: Cash Price |
$5,755.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,232.80
|
| Rate for Payer: Cigna of CA HMO |
$8,186.24
|
| Rate for Payer: Cigna of CA PPO |
$9,465.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$10,872.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,511.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$9,593.25
|
| Rate for Payer: Networks By Design Commercial |
$8,314.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,872.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,674.60
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$987.05 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$987.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,357.77
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Cigna of CA HMO |
$7,474.56
|
| Rate for Payer: Cigna of CA PPO |
$8,642.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,007.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,890.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,890.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
