|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$28.53
|
| Rate for Payer: Blue Shield of California EPN |
$18.66
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.27
|
| Rate for Payer: EPIC Health Plan Senior |
$9.09
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: InnovAge PACE Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.18
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.09
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Medicare |
$9.64
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
IP
|
$11,336.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,267.20 |
| Max. Negotiated Rate |
$10,202.40 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Cash Price |
$6,234.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,068.80
|
| 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 Permanente of CA Commercial/Self Funded |
$7,561.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,319.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,016.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
OP
|
$11,336.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.49 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,884.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,880.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,500.39
|
| Rate for Payer: Cash Price |
$6,234.80
|
| Rate for Payer: Cash Price |
$6,234.80
|
| 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 |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| 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 |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$249.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,561.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| 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 |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| 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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
IP
|
$7,557.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,511.40 |
| Max. Negotiated Rate |
$6,801.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.40
|
| Rate for Payer: Cash Price |
$4,156.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,045.60
|
| 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 Permanente of CA Commercial/Self Funded |
$5,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,879.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,677.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
OP
|
$7,557.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$6,801.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,589.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,587.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,000.13
|
| Rate for Payer: Cash Price |
$4,156.35
|
| Rate for Payer: Cash Price |
$4,156.35
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$6,423.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,449.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,229.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,092.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,089.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$6,423.45
|
| Rate for Payer: Cash Price |
$6,423.45
|
| 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 |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| 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 |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| 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 |
$785.56
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| 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 |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$6,182.10 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,171.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.21
|
| Rate for Payer: Blue Shield of California Commercial |
$4,169.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,726.99
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,495.20
|
| Rate for Payer: Cigna of CA HMO |
$4,396.16
|
| Rate for Payer: Cigna of CA PPO |
$5,083.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,838.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,182.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: Networks By Design Commercial |
$4,464.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,838.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,121.40
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
IP
|
$5,839.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,167.80 |
| Max. Negotiated Rate |
$5,255.10 |
| Rate for Payer: Adventist Health Commercial |
$1,167.80
|
| Rate for Payer: Cash Price |
$3,211.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,671.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,335.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,335.60
|
| Rate for Payer: Galaxy Health WC |
$4,963.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,255.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,894.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,224.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,614.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.80
|
| Rate for Payer: Multiplan Commercial |
$4,379.25
|
| Rate for Payer: Networks By Design Commercial |
$3,795.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,963.15
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
OP
|
$5,839.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$5,255.10 |
| Rate for Payer: Adventist Health Commercial |
$1,167.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,546.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,544.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,318.08
|
| Rate for Payer: Cash Price |
$3,211.45
|
| Rate for Payer: Cash Price |
$3,211.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,671.20
|
| Rate for Payer: Cigna of CA HMO |
$3,736.96
|
| Rate for Payer: Cigna of CA PPO |
$4,320.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,963.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,255.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,894.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$4,379.25
|
| Rate for Payer: Networks By Design Commercial |
$3,795.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,963.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,503.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,503.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,373.80 |
| Max. Negotiated Rate |
$6,182.10 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,747.60
|
| Rate for Payer: Galaxy Health WC |
$5,838.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,182.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,617.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,251.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.80
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: Networks By Design Commercial |
$4,464.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,838.65
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
IP
|
$3,892.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$778.40 |
| Max. Negotiated Rate |
$3,502.80 |
| Rate for Payer: Adventist Health Commercial |
$778.40
|
| Rate for Payer: Cash Price |
$2,140.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,556.80
|
| Rate for Payer: Galaxy Health WC |
$3,308.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,335.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,502.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,595.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,409.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.40
|
| Rate for Payer: Multiplan Commercial |
$2,919.00
|
| Rate for Payer: Networks By Design Commercial |
$2,529.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,308.20
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
OP
|
$4,579.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$4,121.10 |
| Rate for Payer: Adventist Health Commercial |
$915.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,780.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,779.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,817.86
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,663.20
|
| Rate for Payer: Cigna of CA HMO |
$2,930.56
|
| Rate for Payer: Cigna of CA PPO |
$3,388.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,892.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,747.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,121.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,054.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,434.25
|
| Rate for Payer: Networks By Design Commercial |
$2,976.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,892.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,747.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,747.40
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
OP
|
$3,892.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$3,502.80 |
| Rate for Payer: Adventist Health Commercial |
$778.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,363.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,362.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,545.12
|
| Rate for Payer: Cash Price |
$2,140.60
|
| Rate for Payer: Cash Price |
$2,140.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,113.60
|
| Rate for Payer: Cigna of CA HMO |
$2,490.88
|
| Rate for Payer: Cigna of CA PPO |
$2,880.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,308.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,335.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,502.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,595.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$2,919.00
|
| Rate for Payer: Networks By Design Commercial |
$2,529.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,308.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,335.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,335.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
IP
|
$4,579.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$915.80 |
| Max. Negotiated Rate |
$4,121.10 |
| Rate for Payer: Adventist Health Commercial |
$915.80
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,663.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,831.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.60
|
| Rate for Payer: Galaxy Health WC |
$3,892.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,747.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,121.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,054.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,744.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,834.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.80
|
| Rate for Payer: Multiplan Commercial |
$3,434.25
|
| Rate for Payer: Networks By Design Commercial |
$2,976.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,892.15
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
OP
|
$12,791.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.05 |
| Max. Negotiated Rate |
$11,511.90 |
| Rate for Payer: Adventist Health Commercial |
$2,558.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,767.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,764.14
|
| Rate for Payer: Blue Shield of California EPN |
$5,078.03
|
| Rate for Payer: Cash Price |
$7,035.05
|
| Rate for Payer: Cash Price |
$7,035.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,232.80
|
| Rate for Payer: Cigna of CA HMO |
$8,186.24
|
| Rate for Payer: Cigna of CA PPO |
$9,465.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,872.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,511.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,593.25
|
| Rate for Payer: Networks By Design Commercial |
$8,314.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$10,872.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,674.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
IP
|
$12,791.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,558.20 |
| Max. Negotiated Rate |
$11,511.90 |
| Rate for Payer: Adventist Health Commercial |
$2,558.20
|
| Rate for Payer: Cash Price |
$7,035.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,232.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.40
|
| Rate for Payer: Galaxy Health WC |
$10,872.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,511.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,873.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,917.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.20
|
| Rate for Payer: Multiplan Commercial |
$9,593.25
|
| Rate for Payer: Networks By Design Commercial |
$8,314.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,872.35
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
OP
|
$15,048.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.05 |
| Max. Negotiated Rate |
$13,543.20 |
| Rate for Payer: Adventist Health Commercial |
$3,009.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,138.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9,134.14
|
| Rate for Payer: Blue Shield of California EPN |
$5,974.06
|
| Rate for Payer: Cash Price |
$8,276.40
|
| Rate for Payer: Cash Price |
$8,276.40
|
| Rate for Payer: Central Health Plan Commercial |
$12,038.40
|
| Rate for Payer: Cigna of CA HMO |
$9,630.72
|
| Rate for Payer: Cigna of CA PPO |
$11,135.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$12,790.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,028.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,543.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,037.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,009.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$11,286.00
|
| Rate for Payer: Networks By Design Commercial |
$9,781.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$12,790.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,028.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,028.80
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
IP
|
$15,048.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,009.60 |
| Max. Negotiated Rate |
$13,543.20 |
| Rate for Payer: Adventist Health Commercial |
$3,009.60
|
| Rate for Payer: Cash Price |
$8,276.40
|
| Rate for Payer: Central Health Plan Commercial |
$12,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,019.20
|
| Rate for Payer: Galaxy Health WC |
$12,790.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,028.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,543.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,037.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,733.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,009.60
|
| Rate for Payer: Multiplan Commercial |
$11,286.00
|
| Rate for Payer: Networks By Design Commercial |
$9,781.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,790.80
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
OP
|
$13,740.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$12,366.00 |
| Rate for Payer: Adventist Health Commercial |
$2,748.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,344.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8,340.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,454.78
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,992.00
|
| Rate for Payer: Cigna of CA HMO |
$8,793.60
|
| Rate for Payer: Cigna of CA PPO |
$10,167.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,679.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,366.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,748.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,305.00
|
| Rate for Payer: Networks By Design Commercial |
$8,931.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,244.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,244.00
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
IP
|
$13,740.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,748.00 |
| Max. Negotiated Rate |
$12,366.00 |
| Rate for Payer: Adventist Health Commercial |
$2,748.00
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,496.00
|
| Rate for Payer: Galaxy Health WC |
$11,679.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,234.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,505.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,748.00
|
| Rate for Payer: Multiplan Commercial |
$10,305.00
|
| Rate for Payer: Networks By Design Commercial |
$8,931.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.00
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,092.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,089.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$6,423.45
|
| Rate for Payer: Cash Price |
$6,423.45
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$6,423.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,449.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,229.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$6,423.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,449.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,229.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
