|
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 PULMONARY BILAT
|
Facility
|
IP
|
$13,337.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,667.40 |
| Max. Negotiated Rate |
$12,003.30 |
| Rate for Payer: Adventist Health Commercial |
$2,667.40
|
| Rate for Payer: Cash Price |
$6,001.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,669.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,334.80
|
| Rate for Payer: Galaxy Health WC |
$11,336.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,002.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,003.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,081.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,255.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,667.40
|
| Rate for Payer: Multiplan Commercial |
$10,002.75
|
| Rate for Payer: Networks By Design Commercial |
$8,669.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,336.45
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$13,337.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$231.41 |
| Max. Negotiated Rate |
$12,003.30 |
| Rate for Payer: Adventist Health Commercial |
$2,667.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,099.56
|
| 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 |
$8,095.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,294.79
|
| Rate for Payer: Cash Price |
$6,001.65
|
| Rate for Payer: Cash Price |
$6,001.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,669.60
|
| Rate for Payer: Cigna of CA HMO |
$8,535.68
|
| Rate for Payer: Cigna of CA PPO |
$9,869.38
|
| 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 |
$11,336.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,002.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,003.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.41
|
| 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 |
$8,895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,667.40
|
| 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 |
$10,002.75
|
| Rate for Payer: Networks By Design Commercial |
$8,669.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,336.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,002.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,002.20
|
| 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 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 |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,884.35
|
| 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 |
$6,880.95
|
| 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 |
$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 |
$9,635.60
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.41
|
| 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 |
$7,561.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| 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 |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
| 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 |
$6,801.60
|
| 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 |
$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 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: EPIC Health Plan Commercial |
$4,534.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,534.40
|
| Rate for Payer: Galaxy Health WC |
$9,635.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,801.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,202.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,561.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,319.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,016.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,267.20
|
| Rate for Payer: Multiplan Commercial |
$8,502.00
|
| Rate for Payer: Networks By Design Commercial |
$7,368.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,635.60
|
|
|
HC 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: EPIC Health Plan Commercial |
$3,022.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,022.80
|
| Rate for Payer: Galaxy Health WC |
$6,423.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,801.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,879.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,677.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$8,891.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$8,001.90 |
| Rate for Payer: Adventist Health Commercial |
$1,778.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,399.50
|
| 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 |
$2,608.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5,396.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,529.73
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,112.80
|
| Rate for Payer: Cigna of CA HMO |
$5,690.24
|
| Rate for Payer: Cigna of CA PPO |
$6,579.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$7,557.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,334.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,001.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.73
|
| 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 |
$5,930.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,778.20
|
| 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 |
$6,668.25
|
| Rate for Payer: Networks By Design Commercial |
$5,779.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$7,557.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,334.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,334.60
|
| 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 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 |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,589.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,587.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,000.13
|
| Rate for Payer: Cash Price |
$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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,423.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,534.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,801.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,667.75
|
| Rate for Payer: Networks By Design Commercial |
$4,912.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$6,423.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,534.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,534.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$8,891.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,778.20 |
| Max. Negotiated Rate |
$8,001.90 |
| Rate for Payer: Adventist Health Commercial |
$1,778.20
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,556.40
|
| Rate for Payer: Galaxy Health WC |
$7,557.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,334.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,001.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,930.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,387.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,503.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,778.20
|
| Rate for Payer: Multiplan Commercial |
$6,668.25
|
| Rate for Payer: Networks By Design Commercial |
$5,779.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,557.35
|
|
|
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 |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,092.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,089.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,636.56
|
| Rate for Payer: Cash Price |
$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 |
$211.16
|
| 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 |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.26
|
| 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 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: EPIC Health Plan Commercial |
$4,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,671.60
|
| Rate for Payer: Galaxy Health WC |
$9,927.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,511.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,449.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,229.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,335.80
|
| Rate for Payer: Multiplan Commercial |
$8,759.25
|
| Rate for Payer: Networks By Design Commercial |
$7,591.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,927.15
|
|
|
HC 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 |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,628.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9,623.99
|
| 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 |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$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 |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,575.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$11,891.25
|
| Rate for Payer: Networks By Design Commercial |
$10,305.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$13,476.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$10,575.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,040.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,814.25
|
| 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 |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,371.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| Rate for Payer: Blue Shield of California Commercial |
$8,366.89
|
| 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 |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$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 |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,756.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$10,338.00
|
| Rate for Payer: Networks By Design Commercial |
$8,959.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$11,716.40
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$9,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,251.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,532.30
|
| 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 ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$16,217.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$224.05 |
| Max. Negotiated Rate |
$14,595.30 |
| Rate for Payer: Adventist Health Commercial |
$3,243.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,848.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9,843.72
|
| Rate for Payer: Blue Shield of California EPN |
$6,438.15
|
| Rate for Payer: Cash Price |
$7,297.65
|
| Rate for Payer: Cash Price |
$7,297.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,973.60
|
| Rate for Payer: Cigna of CA HMO |
$10,378.88
|
| Rate for Payer: Cigna of CA PPO |
$12,000.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$13,784.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,595.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,816.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,243.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$12,162.75
|
| Rate for Payer: Networks By Design Commercial |
$10,541.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$13,784.45
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,730.20
|
| 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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$16,217.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,243.40 |
| Max. Negotiated Rate |
$14,595.30 |
| Rate for Payer: Adventist Health Commercial |
$3,243.40
|
| Rate for Payer: Cash Price |
$7,297.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,973.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,486.80
|
| Rate for Payer: Galaxy Health WC |
$13,784.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,595.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,816.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,178.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,038.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,243.40
|
| Rate for Payer: Multiplan Commercial |
$12,162.75
|
| Rate for Payer: Networks By Design Commercial |
$10,541.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,784.45
|
|
|
HC ANGIOGRAPHY ARTERIOVENOUS SHNT
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
CPT 75791
|
| Hospital Charge Code |
909020048
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,862.00 |
| Rate for Payer: Adventist Health Commercial |
$636.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,931.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,703.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,749.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,385.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,539.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,867.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,930.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,262.46
|
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,544.00
|
| Rate for Payer: Cigna of CA HMO |
$2,035.20
|
| Rate for Payer: Cigna of CA PPO |
$2,353.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,703.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,703.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,703.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,272.00
|
| Rate for Payer: Galaxy Health WC |
$2,703.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,862.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,968.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,226.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,226.00
|
| Rate for Payer: Multiplan Commercial |
$2,385.00
|
| Rate for Payer: Networks By Design Commercial |
$2,067.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,703.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,908.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,908.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,590.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,590.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,590.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,590.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,703.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,703.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,703.00
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$557.10
|
| 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 |
$528.57
|
| Rate for Payer: Blue Shield of California Commercial |
$549.90
|
| 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: 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: InnovAge PACE Commercial |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$557.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$630.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$896.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.26
|
| 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: 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: InnovAge PACE Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$1,252.26
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| 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 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 |
$2,272.62
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| 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 |
$1,627.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,272.62
|
| 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: 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: InnovAge PACE Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,960.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,819.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,058.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,043.55
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| 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
|
|
