|
HC ANTI-XA APIXABAN
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$80.91 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$35.21
|
| Rate for Payer: Blue Shield of California EPN |
$23.03
|
| Rate for Payer: Cash Price |
$31.90
|
| Rate for Payer: Cash Price |
$31.90
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: InnovAge PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.42
|
| Rate for Payer: Blue Shield of California Commercial |
$72.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: InnovAge PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.09
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,465.20 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,465.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$620.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.14 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$895.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$788.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.12
|
| 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 |
$895.40
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,302.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.92
|
| Rate for Payer: Cigna of CA PPO |
$1,204.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,383.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,465.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.14
|
| Rate for Payer: InnovAge PACE Commercial |
$814.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,139.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
| Rate for Payer: Riverside University Health System MISP |
$651.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.80
|
| 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 |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,383.80
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.14 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$761.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,038.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$670.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$812.82
|
| 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 |
$761.20
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,107.20
|
| Rate for Payer: Cigna of CA HMO |
$885.76
|
| Rate for Payer: Cigna of CA PPO |
$1,024.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,176.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.60
|
| Rate for Payer: EPIC Health Plan Senior |
$553.60
|
| Rate for Payer: Galaxy Health WC |
$1,176.40
|
| Rate for Payer: Global Benefits Group Commercial |
$830.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,245.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.14
|
| Rate for Payer: InnovAge PACE Commercial |
$692.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$856.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$968.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: Networks By Design Commercial |
$899.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,176.40
|
| Rate for Payer: Riverside University Health System MISP |
$553.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$830.40
|
| 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 |
$1,176.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,176.40
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.80 |
| Max. Negotiated Rate |
$1,245.60 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.60
|
| Rate for Payer: EPIC Health Plan Senior |
$553.60
|
| Rate for Payer: Galaxy Health WC |
$1,176.40
|
| Rate for Payer: Global Benefits Group Commercial |
$830.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,245.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$856.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.80
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: Networks By Design Commercial |
$899.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,176.40
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,043.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$408.60 |
| Max. Negotiated Rate |
$1,838.70 |
| Rate for Payer: Adventist Health Commercial |
$408.60
|
| Rate for Payer: Cash Price |
$1,123.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,634.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$817.20
|
| Rate for Payer: EPIC Health Plan Senior |
$817.20
|
| Rate for Payer: Galaxy Health WC |
$1,736.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,225.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,838.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,362.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$778.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.25
|
| Rate for Payer: Networks By Design Commercial |
$1,327.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,736.55
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$480.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,322.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,803.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,164.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,411.87
|
| 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 |
$1,322.20
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,923.20
|
| Rate for Payer: Cigna of CA HMO |
$1,562.60
|
| Rate for Payer: Cigna of CA PPO |
$1,778.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,043.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,043.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,163.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,202.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,682.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,682.80
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
| Rate for Payer: Riverside University Health System MISP |
$961.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,442.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,442.40
|
| 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 |
$2,043.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,043.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,043.40
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,043.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$408.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,736.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,123.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,532.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$989.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,199.85
|
| 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 |
$1,123.65
|
| Rate for Payer: Cash Price |
$1,123.65
|
| Rate for Payer: Cash Price |
$1,123.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,634.40
|
| Rate for Payer: Cigna of CA HMO |
$1,327.95
|
| Rate for Payer: Cigna of CA PPO |
$1,511.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,736.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,736.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,736.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$817.20
|
| Rate for Payer: EPIC Health Plan Senior |
$817.20
|
| Rate for Payer: Galaxy Health WC |
$1,736.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,225.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,838.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,021.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,362.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,430.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,430.10
|
| Rate for Payer: Multiplan Commercial |
$1,532.25
|
| Rate for Payer: Networks By Design Commercial |
$1,327.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,736.55
|
| Rate for Payer: Riverside University Health System MISP |
$817.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,225.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,225.80
|
| 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 |
$1,736.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,736.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,736.55
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$2,163.60 |
| Rate for Payer: Adventist Health Commercial |
$480.80
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,163.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$915.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,488.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.80
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$12,696.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$197.77 |
| Max. Negotiated Rate |
$11,426.40 |
| Rate for Payer: Adventist Health Commercial |
$2,539.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,710.28
|
| 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 |
$7,706.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,040.31
|
| Rate for Payer: Cash Price |
$6,982.80
|
| Rate for Payer: Cash Price |
$6,982.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,156.80
|
| Rate for Payer: Cigna of CA HMO |
$8,125.44
|
| Rate for Payer: Cigna of CA PPO |
$9,395.04
|
| 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 |
$10,791.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,617.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,426.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.77
|
| 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 |
$8,468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,522.00
|
| Rate for Payer: Networks By Design Commercial |
$8,252.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$10,791.60
|
| 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 |
$7,617.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,617.60
|
| 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 AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$12,696.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,539.20 |
| Max. Negotiated Rate |
$11,426.40 |
| Rate for Payer: Adventist Health Commercial |
$2,539.20
|
| Rate for Payer: Cash Price |
$6,982.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,078.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,078.40
|
| Rate for Payer: Galaxy Health WC |
$10,791.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,617.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,426.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,837.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,858.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.20
|
| Rate for Payer: Multiplan Commercial |
$9,522.00
|
| Rate for Payer: Networks By Design Commercial |
$8,252.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,791.60
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$14,936.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,987.20 |
| Max. Negotiated Rate |
$13,442.40 |
| Rate for Payer: Adventist Health Commercial |
$2,987.20
|
| Rate for Payer: Cash Price |
$8,214.80
|
| Rate for Payer: Central Health Plan Commercial |
$11,948.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,974.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,974.40
|
| Rate for Payer: Galaxy Health WC |
$12,695.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,961.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,442.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,962.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,690.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,245.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,987.20
|
| Rate for Payer: Multiplan Commercial |
$11,202.00
|
| Rate for Payer: Networks By Design Commercial |
$9,708.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,695.60
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$14,936.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$197.77 |
| Max. Negotiated Rate |
$13,442.40 |
| Rate for Payer: Adventist Health Commercial |
$2,987.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,070.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9,066.15
|
| Rate for Payer: Blue Shield of California EPN |
$5,929.59
|
| Rate for Payer: Cash Price |
$8,214.80
|
| Rate for Payer: Cash Price |
$8,214.80
|
| Rate for Payer: Central Health Plan Commercial |
$11,948.80
|
| Rate for Payer: Cigna of CA HMO |
$9,559.04
|
| Rate for Payer: Cigna of CA PPO |
$11,052.64
|
| 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 |
$12,695.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,961.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,442.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,962.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,987.20
|
| 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 |
$11,202.00
|
| Rate for Payer: Networks By Design Commercial |
$9,708.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$12,695.60
|
| 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 |
$8,961.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,961.60
|
| 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 AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,013.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,802.60 |
| Max. Negotiated Rate |
$12,611.70 |
| Rate for Payer: Adventist Health Commercial |
$2,802.60
|
| Rate for Payer: Cash Price |
$7,707.15
|
| Rate for Payer: Central Health Plan Commercial |
$11,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,605.20
|
| Rate for Payer: Galaxy Health WC |
$11,911.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,407.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,611.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,346.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,338.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,674.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.60
|
| Rate for Payer: Multiplan Commercial |
$10,509.75
|
| Rate for Payer: Networks By Design Commercial |
$9,108.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,911.05
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$16,486.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,297.20 |
| Max. Negotiated Rate |
$14,837.40 |
| Rate for Payer: Adventist Health Commercial |
$3,297.20
|
| Rate for Payer: Cash Price |
$9,067.30
|
| Rate for Payer: Central Health Plan Commercial |
$13,188.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,594.40
|
| Rate for Payer: Galaxy Health WC |
$14,013.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,837.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,996.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,281.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,204.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.20
|
| Rate for Payer: Multiplan Commercial |
$12,364.50
|
| Rate for Payer: Networks By Design Commercial |
$10,715.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,013.10
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$16,486.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$14,837.40 |
| Rate for Payer: Adventist Health Commercial |
$3,297.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,011.95
|
| 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 |
$2,718.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$551.70
|
| Rate for Payer: Blue Shield of California Commercial |
$10,007.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,544.94
|
| Rate for Payer: Cash Price |
$9,067.30
|
| Rate for Payer: Cash Price |
$9,067.30
|
| Rate for Payer: Central Health Plan Commercial |
$13,188.80
|
| Rate for Payer: Cigna of CA HMO |
$10,551.04
|
| Rate for Payer: Cigna of CA PPO |
$12,199.64
|
| 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 |
$14,013.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,837.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.62
|
| 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 |
$10,996.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.20
|
| 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 |
$12,364.50
|
| Rate for Payer: Networks By Design Commercial |
$10,715.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$14,013.10
|
| 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 |
$9,891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,891.60
|
| 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 AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,013.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$12,611.70 |
| Rate for Payer: Adventist Health Commercial |
$2,802.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,510.09
|
| 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 |
$2,718.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$551.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8,505.89
|
| Rate for Payer: Blue Shield of California EPN |
$5,563.16
|
| Rate for Payer: Cash Price |
$7,707.15
|
| Rate for Payer: Cash Price |
$7,707.15
|
| Rate for Payer: Central Health Plan Commercial |
$11,210.40
|
| Rate for Payer: Cigna of CA HMO |
$8,968.32
|
| Rate for Payer: Cigna of CA PPO |
$10,369.62
|
| 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 |
$11,911.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,407.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,611.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,346.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.60
|
| 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 |
$10,509.75
|
| Rate for Payer: Networks By Design Commercial |
$9,108.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,911.05
|
| 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 |
$8,407.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,407.80
|
| 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 AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,013.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$244.62 |
| Max. Negotiated Rate |
$12,611.70 |
| Rate for Payer: Adventist Health Commercial |
$2,802.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,510.09
|
| 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 |
$2,718.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,229.83
|
| 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 |
$7,707.15
|
| Rate for Payer: Cash Price |
$7,707.15
|
| Rate for Payer: Cash Price |
$7,707.15
|
| Rate for Payer: Central Health Plan Commercial |
$11,210.40
|
| Rate for Payer: Cigna of CA HMO |
$8,968.32
|
| Rate for Payer: Cigna of CA PPO |
$10,369.62
|
| 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 |
$11,911.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,407.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,611.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,346.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.60
|
| 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 |
$10,509.75
|
| Rate for Payer: Networks By Design Commercial |
$9,108.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,911.05
|
| 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 |
$8,407.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,407.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,013.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,802.60 |
| Max. Negotiated Rate |
$12,611.70 |
| Rate for Payer: Adventist Health Commercial |
$2,802.60
|
| Rate for Payer: Cash Price |
$7,707.15
|
| Rate for Payer: Central Health Plan Commercial |
$11,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,605.20
|
| Rate for Payer: Galaxy Health WC |
$11,911.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,407.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,611.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,346.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,338.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,674.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,802.60
|
| Rate for Payer: Multiplan Commercial |
$10,509.75
|
| Rate for Payer: Networks By Design Commercial |
$9,108.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,911.05
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$11,450.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$190.15 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$2,290.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,953.59
|
| 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 |
$6,950.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,545.65
|
| Rate for Payer: Cash Price |
$6,297.50
|
| Rate for Payer: Cash Price |
$6,297.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,160.00
|
| Rate for Payer: Cigna of CA HMO |
$7,328.00
|
| Rate for Payer: Cigna of CA PPO |
$8,473.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$9,732.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,305.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,637.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,290.00
|
| 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 |
$8,587.50
|
| Rate for Payer: Networks By Design Commercial |
$7,442.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$9,732.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,870.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,870.00
|
| 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 AORTOGRAPH THORACIC
|
Facility
|
OP
|
$13,470.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$190.15 |
| Max. Negotiated Rate |
$12,123.00 |
| Rate for Payer: Adventist Health Commercial |
$2,694.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,180.33
|
| 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 |
$8,176.29
|
| Rate for Payer: Blue Shield of California EPN |
$5,347.59
|
| Rate for Payer: Cash Price |
$7,408.50
|
| Rate for Payer: Cash Price |
$7,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,776.00
|
| Rate for Payer: Cigna of CA HMO |
$8,620.80
|
| Rate for Payer: Cigna of CA PPO |
$9,967.80
|
| 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 |
$11,449.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,082.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,123.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.15
|
| 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 |
$8,984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,694.00
|
| 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 |
$10,102.50
|
| Rate for Payer: Networks By Design Commercial |
$8,755.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Prime Health Services Commercial |
$11,449.50
|
| 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 |
$8,082.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,082.00
|
| 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 AORTOGRAPH THORACIC
|
Facility
|
IP
|
$13,470.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,694.00 |
| Max. Negotiated Rate |
$12,123.00 |
| Rate for Payer: Adventist Health Commercial |
$2,694.00
|
| Rate for Payer: Cash Price |
$7,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,388.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,388.00
|
| Rate for Payer: Galaxy Health WC |
$11,449.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,082.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,132.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,337.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,694.00
|
| Rate for Payer: Multiplan Commercial |
$10,102.50
|
| Rate for Payer: Networks By Design Commercial |
$8,755.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,449.50
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$11,450.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,290.00 |
| Max. Negotiated Rate |
$10,305.00 |
| Rate for Payer: Adventist Health Commercial |
$2,290.00
|
| Rate for Payer: Cash Price |
$6,297.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,580.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,580.00
|
| Rate for Payer: Galaxy Health WC |
$9,732.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,637.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,362.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,087.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,290.00
|
| Rate for Payer: Multiplan Commercial |
$8,587.50
|
| Rate for Payer: Networks By Design Commercial |
$7,442.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,732.50
|
|
