|
HC VENOGRAM EXRTM BILATERAL
|
Facility
IP
|
$5,973.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,194.60 |
| Max. Negotiated Rate |
$5,375.70 |
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,778.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,389.20
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,375.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.60
|
| Rate for Payer: Multiplan Commercial |
$4,479.75
|
| Rate for Payer: Networks By Design Commercial |
$3,882.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
OP
|
$5,973.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.55 |
| Max. Negotiated Rate |
$5,375.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.91
|
| Rate for Payer: BCBS Transplant Transplant |
$3,583.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,691.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,902.88
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,778.40
|
| Rate for Payer: Cigna of CA HMO |
$3,822.72
|
| Rate for Payer: Cigna of CA PPO |
$4,420.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,375.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,479.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: IEHP medi-cal |
$3,301.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Innovage PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,479.75
|
| Rate for Payer: Networks By Design Commercial |
$3,882.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,583.80
|
| Rate for Payer: Riverside University Health MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,583.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,583.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$796.40 |
| Max. Negotiated Rate |
$3,583.80 |
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,592.80
|
| Rate for Payer: Galaxy Health WC |
$3,384.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,389.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,583.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,655.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.40
|
| Rate for Payer: Multiplan Commercial |
$2,986.50
|
| Rate for Payer: Networks By Design Commercial |
$2,588.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,384.70
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$796.40 |
| Max. Negotiated Rate |
$3,583.80 |
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,592.80
|
| Rate for Payer: Galaxy Health WC |
$3,384.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,389.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,583.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,655.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.40
|
| Rate for Payer: Multiplan Commercial |
$2,986.50
|
| Rate for Payer: Networks By Design Commercial |
$2,588.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,384.70
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.10 |
| Max. Negotiated Rate |
$3,583.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$509.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2,389.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,460.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,935.25
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,185.60
|
| Rate for Payer: Cigna of CA HMO |
$2,548.48
|
| Rate for Payer: Cigna of CA PPO |
$2,946.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,384.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,389.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,583.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,986.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: IEHP medi-cal |
$3,301.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Innovage PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$2,986.50
|
| Rate for Payer: Networks By Design Commercial |
$2,588.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,384.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,389.20
|
| Rate for Payer: Riverside University Health MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,389.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,389.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.10 |
| Max. Negotiated Rate |
$3,583.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$509.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.20
|
| Rate for Payer: BCBS Transplant Transplant |
$2,389.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,460.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,935.25
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,185.60
|
| Rate for Payer: Cigna of CA HMO |
$2,548.48
|
| Rate for Payer: Cigna of CA PPO |
$2,946.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,384.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,389.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,583.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,986.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: IEHP medi-cal |
$3,301.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Innovage PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,655.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$2,986.50
|
| Rate for Payer: Networks By Design Commercial |
$2,588.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,384.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,389.20
|
| Rate for Payer: Riverside University Health MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,389.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,389.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
IP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,617.00 |
| Max. Negotiated Rate |
$11,776.50 |
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,234.00
|
| Rate for Payer: Galaxy Health WC |
$11,122.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,776.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,727.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,617.00
|
| Rate for Payer: Multiplan Commercial |
$9,813.75
|
| Rate for Payer: Networks By Design Commercial |
$8,505.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,122.25
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
OP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$843.35 |
| Max. Negotiated Rate |
$11,776.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$843.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: BCBS Transplant Transplant |
$7,851.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,086.53
|
| Rate for Payer: Blue Shield of California EPN |
$6,359.31
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,468.00
|
| Rate for Payer: Cigna of CA HMO |
$8,374.40
|
| Rate for Payer: Cigna of CA PPO |
$9,682.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,122.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,776.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,813.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,727.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,617.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,813.75
|
| Rate for Payer: Networks By Design Commercial |
$8,505.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,122.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,851.00
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,851.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,851.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
IP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,617.00 |
| Max. Negotiated Rate |
$11,776.50 |
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,234.00
|
| Rate for Payer: Galaxy Health WC |
$11,122.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,776.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,727.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,617.00
|
| Rate for Payer: Multiplan Commercial |
$9,813.75
|
| Rate for Payer: Networks By Design Commercial |
$8,505.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,122.25
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
OP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$843.35 |
| Max. Negotiated Rate |
$11,776.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$843.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: BCBS Transplant Transplant |
$7,851.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,086.53
|
| Rate for Payer: Blue Shield of California EPN |
$6,359.31
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,468.00
|
| Rate for Payer: Cigna of CA HMO |
$8,374.40
|
| Rate for Payer: Cigna of CA PPO |
$9,682.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,122.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,851.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,776.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,813.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,727.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,617.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,813.75
|
| Rate for Payer: Networks By Design Commercial |
$8,505.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,122.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,851.00
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,851.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,851.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,389.60 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$872.01 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$872.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: BCBS Transplant Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,383.86
|
| Rate for Payer: Blue Shield of California EPN |
$5,806.73
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,389.60 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$872.01 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$872.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: BCBS Transplant Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,383.86
|
| Rate for Payer: Blue Shield of California EPN |
$5,806.73
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM ORBITAL
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.10 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$765.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.20
|
| Rate for Payer: BCBS Transplant Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,383.86
|
| Rate for Payer: Blue Shield of California EPN |
$5,806.73
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: IEHP medi-cal |
$1,295.08
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: Riverside University Health MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC VENOGRAM ORBITAL
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,389.60 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
OP
|
$11,597.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$954.16 |
| Max. Negotiated Rate |
$10,437.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$954.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: BCBS Transplant Transplant |
$6,958.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,166.95
|
| Rate for Payer: Blue Shield of California EPN |
$5,636.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,277.60
|
| Rate for Payer: Cigna of CA HMO |
$7,422.08
|
| Rate for Payer: Cigna of CA PPO |
$8,581.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,437.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,697.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,319.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,697.75
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,958.20
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,958.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,958.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
IP
|
$11,597.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,319.40 |
| Max. Negotiated Rate |
$10,437.30 |
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,638.80
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,437.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,319.40
|
| Rate for Payer: Multiplan Commercial |
$8,697.75
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$6,957.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,621.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,197.52
|
| Rate for Payer: BCBS Transplant Transplant |
$4,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,777.76
|
| Rate for Payer: Blue Shield of California EPN |
$3,757.27
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.80
|
| Rate for Payer: Cigna of CA HMO |
$4,947.84
|
| Rate for Payer: Cigna of CA PPO |
$5,720.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,798.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,638.60
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,546.20 |
| Max. Negotiated Rate |
$6,957.90 |
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.20
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
IP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,298.60 |
| Max. Negotiated Rate |
$5,843.70 |
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,597.20
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,843.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.60
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
OP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$860.53 |
| Max. Negotiated Rate |
$5,843.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$860.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: BCBS Transplant Transplant |
$3,895.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,012.67
|
| Rate for Payer: Blue Shield of California EPN |
$3,155.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,194.40
|
| Rate for Payer: Cigna of CA HMO |
$4,155.52
|
| Rate for Payer: Cigna of CA PPO |
$4,804.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,843.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,869.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: IEHP medi-cal |
$3,301.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Innovage PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: Riverside University Health MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,895.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
OP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
906820196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$860.53 |
| Max. Negotiated Rate |
$5,843.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$860.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: BCBS Transplant Transplant |
$3,895.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,012.67
|
| Rate for Payer: Blue Shield of California EPN |
$3,155.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,194.40
|
| Rate for Payer: Cigna of CA HMO |
$4,155.52
|
| Rate for Payer: Cigna of CA PPO |
$4,804.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,843.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,869.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: IEHP medi-cal |
$3,301.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Innovage PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: Riverside University Health MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,895.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
IP
|
$6,493.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
906820196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,298.60 |
| Max. Negotiated Rate |
$5,843.70 |
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,597.20
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,843.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.60
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,571.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$864.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: BCBS Transplant Transplant |
$2,548.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,625.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,064.53
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,398.40
|
| Rate for Payer: Cigna of CA HMO |
$2,718.72
|
| Rate for Payer: Cigna of CA PPO |
$3,143.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$3,610.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,548.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,823.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,186.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,833.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
| Rate for Payer: Networks By Design Commercial |
$2,761.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,610.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,548.80
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,548.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,548.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
