|
HC VENOGRAM ORBITAL
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.10 |
| 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 |
$865.99
|
| 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 |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.63
|
| 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 RENAL BILAT
|
Facility
|
OP
|
$11,336.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,080.01 |
| Max. Negotiated Rate |
$10,202.40 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.01
|
| 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 |
$7,141.68
|
| 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 |
$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 |
$7,935.20
|
| 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 |
$9,635.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,801.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,202.40
|
| Rate for Payer: 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 |
$7,198.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
| 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 |
$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: 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 RENAL BILAT
|
Facility
|
IP
|
$11,336.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
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 RENAL UNILAT
|
Facility
|
IP
|
$7,557.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
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 RENAL UNILAT
|
Facility
|
OP
|
$7,557.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$976.25 |
| 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 |
$976.25
|
| 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 |
$2,621.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,644.45
|
| 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 SUPERIOR VENACAVA
|
Facility
|
IP
|
$6,347.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,269.40 |
| Max. Negotiated Rate |
$5,712.30 |
| Rate for Payer: Adventist Health Commercial |
$1,269.40
|
| Rate for Payer: Cash Price |
$2,856.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,077.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,442.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,538.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,538.80
|
| Rate for Payer: Galaxy Health WC |
$5,394.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,712.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,030.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,744.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,269.40
|
| Rate for Payer: Multiplan Commercial |
$4,760.25
|
| Rate for Payer: Networks By Design Commercial |
$4,125.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,394.95
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
OP
|
$6,347.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.91 |
| Max. Negotiated Rate |
$5,712.30 |
| Rate for Payer: Adventist Health Commercial |
$1,269.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$974.10
|
| 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 |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,998.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,519.76
|
| Rate for Payer: Cash Price |
$2,856.15
|
| Rate for Payer: Cash Price |
$2,856.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,077.60
|
| Rate for Payer: Cigna of CA HMO |
$4,062.08
|
| Rate for Payer: Cigna of CA PPO |
$4,696.78
|
| 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 |
$4,442.90
|
| 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 |
$5,394.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,712.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,030.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,269.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,760.25
|
| Rate for Payer: Networks By Design Commercial |
$4,125.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Prime Health Services Commercial |
$5,394.95
|
| 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 |
$3,808.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,808.20
|
| 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 SUP SAG SINUS
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$830.40 |
| Max. Negotiated Rate |
$3,736.80 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,321.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,660.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,660.80
|
| Rate for Payer: Galaxy Health WC |
$3,529.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,491.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,736.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,636.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,449.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.40
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| Rate for Payer: Networks By Design Commercial |
$2,698.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,529.20
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.40
|
| 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 |
$2,615.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,648.34
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,321.60
|
| Rate for Payer: Cigna of CA HMO |
$2,657.28
|
| Rate for Payer: Cigna of CA PPO |
$3,072.48
|
| 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 |
$2,906.40
|
| 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 |
$3,529.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,491.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,736.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$229.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,636.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| Rate for Payer: Networks By Design Commercial |
$2,698.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,529.20
|
| 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 |
$2,491.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,491.20
|
| 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 |
$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 VENOGRAPHY AZYGOS HEMIAZYGOS VENOUS
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93585
|
| Hospital Charge Code |
906811585
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,738.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOGRAPHY AZYGOS HEMIAZYGOS VENOUS
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93585
|
| Hospital Charge Code |
906811585
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOGRAPHY CONG HEART DEFECT
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93584
|
| Hospital Charge Code |
906811584
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOGRAPHY CONG HEART DEFECT
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93584
|
| Hospital Charge Code |
906811584
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,738.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOGRAPHY CORONARY SINUS
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93586
|
| Hospital Charge Code |
906811586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,738.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOGRAPHY CORONARY SINUS
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93586
|
| Hospital Charge Code |
906811586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$659.70 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Central Health Plan Commercial |
$586.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$513.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$293.20
|
| Rate for Payer: Galaxy Health WC |
$623.05
|
| Rate for Payer: Global Benefits Group Commercial |
$439.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$659.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$465.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$432.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.60
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: Networks By Design Commercial |
$476.45
|
| Rate for Payer: Prime Health Services Commercial |
$623.05
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Central Health Plan Commercial |
$586.40
|
| Rate for Payer: Cigna of CA HMO |
$469.12
|
| Rate for Payer: Cigna of CA PPO |
$542.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$623.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$513.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$293.20
|
| Rate for Payer: Galaxy Health WC |
$623.05
|
| Rate for Payer: Global Benefits Group Commercial |
$439.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$659.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$465.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$432.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$513.10
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: Networks By Design Commercial |
$476.45
|
| Rate for Payer: Prime Health Services Commercial |
$623.05
|
| Rate for Payer: Riverside University Health System MISP |
$293.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.05
|
| Rate for Payer: Vantage Medical Group Senior |
$623.05
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$405.90 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: EPIC Health Plan Senior |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$286.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$338.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: Cigna of CA HMO |
$288.64
|
| Rate for Payer: Cigna of CA PPO |
$333.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$383.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: EPIC Health Plan Senior |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$286.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$315.70
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
| Rate for Payer: Riverside University Health System MISP |
$180.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Vantage Medical Group Senior |
$383.35
|
|
|
HC VENOUS ACCESS PORT
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,595.70 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,329.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$809.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$972.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,421.95
|
| Rate for Payer: Blue Shield of California EPN |
$893.59
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,418.40
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,507.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,507.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,241.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$709.20
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,595.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,125.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$643.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,046.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,241.10
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: Networks By Design Commercial |
$886.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
| Rate for Payer: Riverside University Health System MISP |
$709.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,063.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,063.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$665.41
|
| Rate for Payer: United Healthcare All Other HMO |
$647.68
|
| Rate for Payer: United Healthcare HMO Rider |
$633.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
HC VENOUS ACCESS PORT
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$1,595.70 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,421.95
|
| Rate for Payer: Blue Shield of California EPN |
$893.59
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,418.40
|
| Rate for Payer: Cigna of CA HMO |
$1,241.10
|
| Rate for Payer: Cigna of CA PPO |
$1,241.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,241.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$709.20
|
| Rate for Payer: Galaxy Health WC |
$1,507.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,595.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,125.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,046.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.60
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: Networks By Design Commercial |
$886.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,507.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$665.41
|
| Rate for Payer: United Healthcare All Other HMO |
$647.68
|
| Rate for Payer: United Healthcare HMO Rider |
$633.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.66
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$720.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: Cigna of CA HMO |
$614.40
|
| Rate for Payer: Cigna of CA PPO |
$710.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$816.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$816.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$816.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$609.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$566.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
| Rate for Payer: Riverside University Health System MISP |
$384.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$816.00
|
| Rate for Payer: Vantage Medical Group Senior |
$816.00
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$609.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$566.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,548.40 |
| Max. Negotiated Rate |
$15,967.80 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Central Health Plan Commercial |
$14,193.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,419.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,096.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,096.80
|
| Rate for Payer: Galaxy Health WC |
$15,080.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,645.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,967.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,266.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,467.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.40
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
| Rate for Payer: Networks By Design Commercial |
$11,532.30
|
| Rate for Payer: Prime Health Services Commercial |
$15,080.70
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Central Health Plan Commercial |
$14,193.60
|
| Rate for Payer: Cigna of CA HMO |
$11,354.88
|
| Rate for Payer: Cigna of CA PPO |
$13,129.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,419.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$15,080.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,645.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,967.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,412.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,266.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,874.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$11,532.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$15,080.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,645.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,871.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
