|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$5,134.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$129.89 |
| Max. Negotiated Rate |
$4,620.60 |
| Rate for Payer: Adventist Health Commercial |
$1,026.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,117.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,850.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,116.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,038.20
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,107.20
|
| Rate for Payer: Cigna of CA HMO |
$3,285.76
|
| Rate for Payer: Cigna of CA PPO |
$3,799.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,363.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.60
|
| Rate for Payer: Galaxy Health WC |
$4,363.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,080.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,620.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.89
|
| Rate for Payer: InnovAge PACE Commercial |
$2,567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,424.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,593.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,593.80
|
| Rate for Payer: Multiplan Commercial |
$3,850.50
|
| Rate for Payer: Networks By Design Commercial |
$3,337.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,053.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,080.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,080.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,567.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,567.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,567.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,567.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,363.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.90
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$4,364.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$872.80 |
| Max. Negotiated Rate |
$3,927.60 |
| Rate for Payer: Adventist Health Commercial |
$872.80
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,491.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,745.60
|
| Rate for Payer: Galaxy Health WC |
$3,709.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,618.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,927.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,910.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,662.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,701.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$872.80
|
| Rate for Payer: Multiplan Commercial |
$3,273.00
|
| Rate for Payer: Networks By Design Commercial |
$2,836.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,709.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$5,134.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,026.80 |
| Max. Negotiated Rate |
$4,620.60 |
| Rate for Payer: Adventist Health Commercial |
$1,026.80
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.60
|
| Rate for Payer: Galaxy Health WC |
$4,363.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,080.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,620.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,424.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,956.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.80
|
| Rate for Payer: Multiplan Commercial |
$3,850.50
|
| Rate for Payer: Networks By Design Commercial |
$3,337.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.90
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$4,364.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$129.89 |
| Max. Negotiated Rate |
$3,927.60 |
| Rate for Payer: Adventist Health Commercial |
$872.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,650.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,709.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,400.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,273.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,648.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,732.51
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,491.20
|
| Rate for Payer: Cigna of CA HMO |
$2,792.96
|
| Rate for Payer: Cigna of CA PPO |
$3,229.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,709.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,709.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,709.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,745.60
|
| Rate for Payer: Galaxy Health WC |
$3,709.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,618.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,927.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.89
|
| Rate for Payer: InnovAge PACE Commercial |
$2,182.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,910.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,701.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$872.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,054.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,054.80
|
| Rate for Payer: Multiplan Commercial |
$3,273.00
|
| Rate for Payer: Networks By Design Commercial |
$2,836.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,709.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,745.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,618.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,618.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,182.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,182.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,182.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,709.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,709.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,709.40
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,029.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$605.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,665.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,271.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,466.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,423.20
|
| Rate for Payer: Cigna of CA HMO |
$1,968.85
|
| Rate for Payer: Cigna of CA PPO |
$2,241.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,574.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,574.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,211.60
|
| Rate for Payer: Galaxy Health WC |
$2,574.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,817.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,726.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,514.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,020.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,874.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,120.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,120.30
|
| Rate for Payer: Multiplan Commercial |
$2,271.75
|
| Rate for Payer: Networks By Design Commercial |
$1,968.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,574.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,817.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,817.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,574.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,574.65
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$3,029.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$605.80 |
| Max. Negotiated Rate |
$2,726.10 |
| Rate for Payer: Adventist Health Commercial |
$605.80
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,211.60
|
| Rate for Payer: Galaxy Health WC |
$2,574.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,817.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,726.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,020.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,874.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.80
|
| Rate for Payer: Multiplan Commercial |
$2,271.75
|
| Rate for Payer: Networks By Design Commercial |
$1,968.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,574.65
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$515.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,188.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,416.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,931.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,246.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,512.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.00
|
| Rate for Payer: Cigna of CA HMO |
$1,673.75
|
| Rate for Payer: Cigna of CA PPO |
$1,905.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,188.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,188.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,188.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.00
|
| Rate for Payer: Galaxy Health WC |
$2,188.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,317.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,287.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,717.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,593.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,802.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,802.50
|
| Rate for Payer: Multiplan Commercial |
$1,931.25
|
| Rate for Payer: Networks By Design Commercial |
$1,673.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,188.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,030.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,188.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,188.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,188.75
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$515.00 |
| Max. Negotiated Rate |
$2,317.50 |
| Rate for Payer: Adventist Health Commercial |
$515.00
|
| Rate for Payer: Cash Price |
$1,158.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.00
|
| Rate for Payer: Galaxy Health WC |
$2,188.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,317.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,717.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,593.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.00
|
| Rate for Payer: Multiplan Commercial |
$1,931.25
|
| Rate for Payer: Networks By Design Commercial |
$1,673.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,188.75
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
IP
|
$12,140.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,428.00 |
| Max. Negotiated Rate |
$10,926.00 |
| Rate for Payer: Adventist Health Commercial |
$2,428.00
|
| Rate for Payer: Cash Price |
$5,463.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,712.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,856.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,856.00
|
| Rate for Payer: Galaxy Health WC |
$10,319.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,284.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,926.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,097.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,625.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,514.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,428.00
|
| Rate for Payer: Multiplan Commercial |
$9,105.00
|
| Rate for Payer: Networks By Design Commercial |
$7,891.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,319.00
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
OP
|
$12,140.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$266.24 |
| Max. Negotiated Rate |
$10,926.00 |
| Rate for Payer: Adventist Health Commercial |
$2,428.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,372.62
|
| 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 |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.27
|
| Rate for Payer: Blue Shield of California Commercial |
$7,368.98
|
| Rate for Payer: Blue Shield of California EPN |
$4,819.58
|
| Rate for Payer: Cash Price |
$5,463.00
|
| Rate for Payer: Cash Price |
$5,463.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,712.00
|
| Rate for Payer: Cigna of CA HMO |
$7,769.60
|
| Rate for Payer: Cigna of CA PPO |
$8,983.60
|
| 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 |
$10,319.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,284.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,926.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.24
|
| 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 |
$8,097.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,428.00
|
| 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 |
$9,105.00
|
| Rate for Payer: Networks By Design Commercial |
$7,891.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$10,319.00
|
| 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 |
$7,284.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,284.00
|
| 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 |
$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 ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$239.89 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Adventist Health Commercial |
$1,590.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,829.25
|
| 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 |
$4,826.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,156.94
|
| Rate for Payer: Cash Price |
$3,578.40
|
| Rate for Payer: Cash Price |
$3,578.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,361.60
|
| Rate for Payer: Cigna of CA HMO |
$5,089.28
|
| Rate for Payer: Cigna of CA PPO |
$5,884.48
|
| 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 |
$6,759.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,771.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,156.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$239.89
|
| 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 |
$5,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,590.40
|
| 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 |
$5,964.00
|
| Rate for Payer: Networks By Design Commercial |
$5,168.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$6,759.20
|
| 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 |
$4,771.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,771.20
|
| 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 ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,590.40 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Adventist Health Commercial |
$1,590.40
|
| Rate for Payer: Cash Price |
$3,578.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,180.80
|
| Rate for Payer: Galaxy Health WC |
$6,759.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,771.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,156.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,029.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,922.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,590.40
|
| Rate for Payer: Multiplan Commercial |
$5,964.00
|
| Rate for Payer: Networks By Design Commercial |
$5,168.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,759.20
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$18,617.40 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,514.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,548.80
|
| Rate for Payer: Cigna of CA HMO |
$13,239.04
|
| Rate for Payer: Cigna of CA PPO |
$15,307.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,583.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,274.40
|
| Rate for Payer: Galaxy Health WC |
$17,583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$12,411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,617.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.41
|
| Rate for Payer: InnovAge PACE Commercial |
$10,343.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,797.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,804.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,137.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,480.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,480.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: Networks By Design Commercial |
$13,445.90
|
| Rate for Payer: Prime Health Services Commercial |
$17,583.10
|
| Rate for Payer: Riverside University Health System MISP |
$8,274.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,411.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$17,583.10
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,137.20 |
| Max. Negotiated Rate |
$18,617.40 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,274.40
|
| Rate for Payer: Galaxy Health WC |
$17,583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$12,411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,617.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,797.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,881.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,804.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: Networks By Design Commercial |
$13,445.90
|
| Rate for Payer: Prime Health Services Commercial |
$17,583.10
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$15,106.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$13,595.40 |
| Rate for Payer: Adventist Health Commercial |
$3,021.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,173.87
|
| 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 |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9,169.34
|
| Rate for Payer: Blue Shield of California EPN |
$5,997.08
|
| Rate for Payer: Cash Price |
$6,797.70
|
| Rate for Payer: Cash Price |
$6,797.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,084.80
|
| Rate for Payer: Cigna of CA HMO |
$9,667.84
|
| Rate for Payer: Cigna of CA PPO |
$11,178.44
|
| 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 |
$12,840.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,063.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,595.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.82
|
| 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 |
$10,075.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,021.20
|
| 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 |
$11,329.50
|
| Rate for Payer: Networks By Design Commercial |
$9,818.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$12,840.10
|
| 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 |
$9,063.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,063.60
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$8,564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,892.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,947.96
|
| 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 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 |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,797.73
|
| 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 |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.27
|
| Rate for Payer: Blue Shield of California Commercial |
$7,793.88
|
| 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 |
$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 |
$10,914.00
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.82
|
| 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 |
$8,564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,568.00
|
| 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 |
$9,630.00
|
| Rate for Payer: Networks By Design Commercial |
$8,346.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$10,914.00
|
| 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 |
$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 |
$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 ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$15,106.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,021.20 |
| Max. Negotiated Rate |
$13,595.40 |
| Rate for Payer: Adventist Health Commercial |
$3,021.20
|
| Rate for Payer: Cash Price |
$6,797.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,084.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,042.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,042.40
|
| Rate for Payer: Galaxy Health WC |
$12,840.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,063.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,595.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,075.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,755.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,350.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,021.20
|
| Rate for Payer: Multiplan Commercial |
$11,329.50
|
| Rate for Payer: Networks By Design Commercial |
$9,818.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,840.10
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$7,355.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,201.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,826.33
|
| 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
|
$12,974.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$234.16 |
| Max. Negotiated Rate |
$11,676.60 |
| Rate for Payer: Adventist Health Commercial |
$2,594.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,879.11
|
| 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 |
$7,875.22
|
| Rate for Payer: Blue Shield of California EPN |
$5,150.68
|
| Rate for Payer: Cash Price |
$5,838.30
|
| Rate for Payer: Cash Price |
$5,838.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,379.20
|
| Rate for Payer: Cigna of CA HMO |
$8,303.36
|
| Rate for Payer: Cigna of CA PPO |
$9,600.76
|
| 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 |
$11,027.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,784.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,676.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$234.16
|
| 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 |
$8,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,594.80
|
| 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 |
$9,730.50
|
| Rate for Payer: Networks By Design Commercial |
$8,433.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,027.90
|
| 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 |
$7,784.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,784.40
|
| 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 |
$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 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 |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,697.30
|
| 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 |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| Rate for Payer: Blue Shield of California Commercial |
$6,694.00
|
| 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 |
$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 |
$9,373.80
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$234.16
|
| 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 |
$7,355.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.60
|
| 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 |
$8,271.00
|
| Rate for Payer: Networks By Design Commercial |
$7,168.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$9,373.80
|
| 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 |
$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 |
$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 ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$12,974.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,594.80 |
| Max. Negotiated Rate |
$11,676.60 |
| Rate for Payer: Adventist Health Commercial |
$2,594.80
|
| Rate for Payer: Cash Price |
$5,838.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,189.60
|
| Rate for Payer: Galaxy Health WC |
$11,027.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,784.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,676.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,943.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,030.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,594.80
|
| Rate for Payer: Multiplan Commercial |
$9,730.50
|
| Rate for Payer: Networks By Design Commercial |
$8,433.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,027.90
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$13,740.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| 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 |
$6,183.00
|
| 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 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 |
$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 |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| 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 |
$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 |
$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) medi-cal |
$250.07
|
| 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 Medi-Cal |
$276.24
|
| 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 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: 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
|
|
