|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$12,840.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$11,556.00 |
| Rate for Payer: Adventist Health Commercial |
$2,568.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,298.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.08
|
| Rate for Payer: Blue Shield of California Commercial |
$8,089.20
|
| Rate for Payer: Blue Shield of California EPN |
$5,097.48
|
| Rate for Payer: Cash Price |
$5,778.00
|
| Rate for Payer: Cash Price |
$5,778.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,272.00
|
| Rate for Payer: Cigna of CA HMO |
$8,217.60
|
| Rate for Payer: Cigna of CA PPO |
$9,501.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$10,914.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,704.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,556.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,153.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,568.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$9,630.00
|
| Rate for Payer: Networks By Design Commercial |
$8,346.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,914.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,704.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,704.00
|
| 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: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$12,840.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,568.00 |
| Max. Negotiated Rate |
$11,556.00 |
| Rate for Payer: Adventist Health Commercial |
$2,568.00
|
| Rate for Payer: Cash Price |
$5,778.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,272.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,988.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,136.00
|
| Rate for Payer: Galaxy Health WC |
$10,914.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,704.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,556.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,153.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,575.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,568.00
|
| Rate for Payer: Multiplan Commercial |
$9,630.00
|
| Rate for Payer: Networks By Design Commercial |
$8,346.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,914.00
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$11,028.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,205.60 |
| Max. Negotiated Rate |
$9,925.20 |
| Rate for Payer: Adventist Health Commercial |
$2,205.60
|
| Rate for Payer: Cash Price |
$4,962.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,822.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,719.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,411.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,411.20
|
| Rate for Payer: Galaxy Health WC |
$9,373.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,616.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,925.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,002.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,506.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.60
|
| Rate for Payer: Multiplan Commercial |
$8,271.00
|
| Rate for Payer: Networks By Design Commercial |
$7,168.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,373.80
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$11,028.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$234.16 |
| Max. Negotiated Rate |
$9,925.20 |
| Rate for Payer: Adventist Health Commercial |
$2,205.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,129.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.13
|
| Rate for Payer: Blue Shield of California Commercial |
$6,947.64
|
| Rate for Payer: Blue Shield of California EPN |
$4,378.12
|
| Rate for Payer: Cash Price |
$4,962.60
|
| Rate for Payer: Cash Price |
$4,962.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,822.40
|
| Rate for Payer: Cigna of CA HMO |
$7,057.92
|
| Rate for Payer: Cigna of CA PPO |
$8,160.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,719.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,373.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,616.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,925.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$234.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,002.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,271.00
|
| Rate for Payer: Networks By Design Commercial |
$7,168.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,373.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,616.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,616.80
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,890.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$250.07 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,131.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,357.77
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Cigna of CA HMO |
$7,474.56
|
| Rate for Payer: Cigna of CA PPO |
$8,642.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,007.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$11,336.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$231.41 |
| Max. Negotiated Rate |
$10,202.40 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.08
|
| Rate for Payer: Blue Shield of California Commercial |
$7,141.68
|
| Rate for Payer: Blue Shield of California EPN |
$4,500.39
|
| Rate for Payer: Cash Price |
$5,101.20
|
| Rate for Payer: Cash Price |
$5,101.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,068.80
|
| Rate for Payer: Cigna of CA HMO |
$7,255.04
|
| Rate for Payer: Cigna of CA PPO |
$8,388.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,935.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,635.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,801.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,202.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,198.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,801.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,801.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$11,336.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,267.20 |
| Max. Negotiated Rate |
$10,202.40 |
| Rate for Payer: Adventist Health Commercial |
$2,267.20
|
| Rate for Payer: Cash Price |
$5,101.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,068.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,935.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,534.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,534.40
|
| Rate for Payer: Galaxy Health WC |
$9,635.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,801.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,202.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,198.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,688.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,557.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$6,801.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,760.91
|
| Rate for Payer: Blue Shield of California EPN |
$3,000.13
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,045.60
|
| Rate for Payer: Cigna of CA HMO |
$4,836.48
|
| Rate for Payer: Cigna of CA PPO |
$5,592.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,289.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$6,423.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,801.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,798.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,534.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,534.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$7,557.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,511.40 |
| Max. Negotiated Rate |
$6,801.30 |
| Rate for Payer: Adventist Health Commercial |
$1,511.40
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,045.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,289.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,022.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,022.80
|
| Rate for Payer: Galaxy Health WC |
$6,423.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,801.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,798.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,458.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$211.16 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,064.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,357.77
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Cigna of CA HMO |
$7,474.56
|
| Rate for Payer: Cigna of CA PPO |
$8,642.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,007.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,335.80 |
| Max. Negotiated Rate |
$10,511.10 |
| Rate for Payer: Adventist Health Commercial |
$2,335.80
|
| Rate for Payer: Cash Price |
$5,255.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,416.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,890.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
OP
|
$15,855.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$363.54 |
| Max. Negotiated Rate |
$14,269.50 |
| Rate for Payer: Adventist Health Commercial |
$3,171.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,125.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,646.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9,988.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,294.44
|
| Rate for Payer: Cash Price |
$7,134.75
|
| Rate for Payer: Cash Price |
$7,134.75
|
| Rate for Payer: Central Health Plan Commercial |
$12,684.00
|
| Rate for Payer: Cigna of CA HMO |
$10,147.20
|
| Rate for Payer: Cigna of CA PPO |
$11,732.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,098.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$13,476.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,513.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,269.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,067.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$11,891.25
|
| Rate for Payer: Networks By Design Commercial |
$10,305.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Prime Health Services Commercial |
$13,476.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,513.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,513.00
|
| 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: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
IP
|
$15,855.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,171.00 |
| Max. Negotiated Rate |
$14,269.50 |
| Rate for Payer: Adventist Health Commercial |
$3,171.00
|
| Rate for Payer: Cash Price |
$7,134.75
|
| Rate for Payer: Central Health Plan Commercial |
$12,684.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,098.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,342.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,342.00
|
| Rate for Payer: Galaxy Health WC |
$13,476.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,513.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,269.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,067.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,354.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,171.00
|
| Rate for Payer: Multiplan Commercial |
$11,891.25
|
| Rate for Payer: Networks By Design Commercial |
$10,305.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,476.75
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$13,784.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$224.05 |
| Max. Negotiated Rate |
$12,405.60 |
| Rate for Payer: Adventist Health Commercial |
$2,756.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,112.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,683.92
|
| Rate for Payer: Blue Shield of California EPN |
$5,472.25
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Central Health Plan Commercial |
$11,027.20
|
| Rate for Payer: Cigna of CA HMO |
$8,821.76
|
| Rate for Payer: Cigna of CA PPO |
$10,200.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,648.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$11,716.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,270.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,405.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,752.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,756.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$10,338.00
|
| Rate for Payer: Networks By Design Commercial |
$8,959.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Prime Health Services Commercial |
$11,716.40
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,270.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,270.40
|
| 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 |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$13,784.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,756.80 |
| Max. Negotiated Rate |
$12,405.60 |
| Rate for Payer: Adventist Health Commercial |
$2,756.80
|
| Rate for Payer: Cash Price |
$6,202.80
|
| Rate for Payer: Central Health Plan Commercial |
$11,027.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,648.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,513.60
|
| Rate for Payer: Galaxy Health WC |
$11,716.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,270.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,405.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,752.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,132.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,756.80
|
| Rate for Payer: Multiplan Commercial |
$10,338.00
|
| Rate for Payer: Networks By Design Commercial |
$8,959.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,716.40
|
|
|
HC ANGIOJET PUMP SET
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$571.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$531.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
HC ANGIOJET PUMP SET
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$546.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$435.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.53
|
| Rate for Payer: Blue Shield of California Commercial |
$570.60
|
| Rate for Payer: Blue Shield of California EPN |
$359.10
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$576.00
|
| Rate for Payer: Cigna of CA PPO |
$666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$630.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$571.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$531.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Riverside University Health System MISP |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.24
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$888.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.24
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health System MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,646.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,357.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,481.76
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,352.00
|
| Rate for Payer: Cigna of CA HMO |
$2,058.00
|
| Rate for Payer: Cigna of CA PPO |
$2,058.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,646.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: Networks By Design Commercial |
$1,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,103.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.85
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$2,646.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,342.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,612.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,357.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,481.76
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,352.00
|
| Rate for Payer: Cigna of CA HMO |
$2,058.00
|
| Rate for Payer: Cigna of CA PPO |
$2,058.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,499.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.00
|
| Rate for Payer: Galaxy Health WC |
$2,499.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,646.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,866.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,067.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,734.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,058.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: Networks By Design Commercial |
$1,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,176.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,103.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,499.00
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.70
|
| Rate for Payer: Blue Shield of California EPN |
$680.40
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$616.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.70
|
| Rate for Payer: Blue Shield of California EPN |
$680.40
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$857.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Riverside University Health System MISP |
$540.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
