|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$11,597.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$255.63 |
| Max. Negotiated Rate |
$10,437.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$912.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,198.96
|
| Rate for Payer: Blue Distinction Transplant |
$6,958.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,166.95
|
| Rate for Payer: Blue Shield of California EPN |
$5,636.14
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,277.60
|
| Rate for Payer: Cigna of CA HMO |
$7,422.08
|
| Rate for Payer: Cigna of CA PPO |
$8,581.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,437.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,697.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,319.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,697.75
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,958.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,958.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$11,597.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,319.40 |
| Max. Negotiated Rate |
$10,437.30 |
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,638.80
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,437.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,418.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,319.40
|
| Rate for Payer: Multiplan Commercial |
$8,697.75
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.16 |
| Max. Negotiated Rate |
$6,957.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$864.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.39
|
| Rate for Payer: Blue Distinction Transplant |
$4,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,777.76
|
| Rate for Payer: Blue Shield of California EPN |
$3,757.27
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.80
|
| Rate for Payer: Cigna of CA HMO |
$4,947.84
|
| Rate for Payer: Cigna of CA PPO |
$5,720.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,798.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,546.20 |
| Max. Negotiated Rate |
$6,957.90 |
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.20
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.16 |
| Max. Negotiated Rate |
$6,957.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$864.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.39
|
| Rate for Payer: Blue Distinction Transplant |
$4,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,777.76
|
| Rate for Payer: Blue Shield of California EPN |
$3,757.27
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.80
|
| Rate for Payer: Cigna of CA HMO |
$4,947.84
|
| Rate for Payer: Cigna of CA PPO |
$5,720.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,798.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,546.20 |
| Max. Negotiated Rate |
$6,957.90 |
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.20
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$233.26 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$940.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: Blue Distinction Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,383.86
|
| Rate for Payer: Blue Shield of California EPN |
$5,806.73
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,961.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,389.60 |
| Max. Negotiated Rate |
$10,753.20 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,753.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,552.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,389.60
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
IP
|
$16,220.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,244.00 |
| Max. Negotiated Rate |
$14,598.00 |
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,976.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,488.00
|
| Rate for Payer: Galaxy Health WC |
$13,787.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,732.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,598.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,818.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,179.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.00
|
| Rate for Payer: Multiplan Commercial |
$12,165.00
|
| Rate for Payer: Networks By Design Commercial |
$10,543.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,787.00
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
OP
|
$16,220.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$401.58 |
| Max. Negotiated Rate |
$14,598.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$994.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,198.96
|
| Rate for Payer: Blue Distinction Transplant |
$9,732.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,023.96
|
| Rate for Payer: Blue Shield of California EPN |
$7,882.92
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,976.00
|
| Rate for Payer: Cigna of CA HMO |
$10,380.80
|
| Rate for Payer: Cigna of CA PPO |
$12,002.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$13,787.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,732.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,598.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,165.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,818.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$12,165.00
|
| Rate for Payer: Networks By Design Commercial |
$10,543.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,787.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,732.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,732.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,820.40 |
| Max. Negotiated Rate |
$12,691.80 |
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,640.80
|
| Rate for Payer: Galaxy Health WC |
$11,986.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,461.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,691.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,406.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,372.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.40
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
| Rate for Payer: Networks By Design Commercial |
$9,166.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,986.70
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$247.49 |
| Max. Negotiated Rate |
$12,691.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$982.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: Blue Distinction Transplant |
$8,461.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,715.04
|
| Rate for Payer: Blue Shield of California EPN |
$6,853.57
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,281.60
|
| Rate for Payer: Cigna of CA HMO |
$9,025.28
|
| Rate for Payer: Cigna of CA PPO |
$10,435.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$11,986.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,461.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,691.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,576.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,406.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
| Rate for Payer: Networks By Design Commercial |
$9,166.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,986.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,461.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,461.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$247.49 |
| Max. Negotiated Rate |
$12,691.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$982.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.45
|
| Rate for Payer: Blue Distinction Transplant |
$8,461.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,715.04
|
| Rate for Payer: Blue Shield of California EPN |
$6,853.57
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,281.60
|
| Rate for Payer: Cigna of CA HMO |
$9,025.28
|
| Rate for Payer: Cigna of CA PPO |
$10,435.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$11,986.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,461.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,691.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,576.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,406.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
| Rate for Payer: Networks By Design Commercial |
$9,166.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,986.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,461.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,461.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,820.40 |
| Max. Negotiated Rate |
$12,691.80 |
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,281.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,640.80
|
| Rate for Payer: Galaxy Health WC |
$11,986.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,461.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,691.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,406.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,372.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.40
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
| Rate for Payer: Networks By Design Commercial |
$9,166.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,986.70
|
|
|
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: 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 |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$435.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.72
|
| Rate for Payer: Blue Distinction Transplant |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$566.10
|
| Rate for Payer: Blue Shield of California EPN |
$440.10
|
| 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 Media |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.00
|
| 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: 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
|
| 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 Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
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: 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: 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: 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 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: Blue Shield of California EPN |
$865.08
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$611.71
|
| Rate for Payer: United Healthcare All Other HMO |
$597.46
|
| Rate for Payer: United Healthcare HMO Rider |
$584.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.60
|
|
|
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: 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 |
$891.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.34
|
| Rate for Payer: Blue Distinction Transplant |
$972.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,215.00
|
| Rate for Payer: Blue Shield of California EPN |
$881.28
|
| 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 Media |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.00
|
| 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: 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: 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 |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
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: 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 |
$1,617.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,342.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,637.58
|
| Rate for Payer: Blue Distinction Transplant |
$1,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,205.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,599.36
|
| 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 Media |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,205.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,029.00
|
| 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: 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: 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 |
$1,470.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,470.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,470.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,470.00
|
| 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 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: Blue Shield of California EPN |
$1,569.96
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,084.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$970.20
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$742.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$616.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$751.95
|
| Rate for Payer: Blue Distinction Transplant |
$810.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.50
|
| Rate for Payer: Blue Shield of California EPN |
$734.40
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Media |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,012.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$472.50
|
| 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: 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: Riverside University Health System MISP |
$540.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO |
$675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$675.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
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: Blue Shield of California EPN |
$720.90
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Other HMO |
$497.88
|
| Rate for Payer: United Healthcare HMO Rider |
$487.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$445.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$1,974.60 |
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: Networks By Design Commercial |
$1,426.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$68.46 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,399.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,206.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,316.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.20
|
| Rate for Payer: Cigna of CA PPO |
$1,623.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Media |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,645.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$767.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: Networks By Design Commercial |
$1,426.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: Riverside University Health System MISP |
$877.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$68.46 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,399.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,206.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,316.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.20
|
| Rate for Payer: Cigna of CA PPO |
$1,623.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Media |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,645.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$767.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: Networks By Design Commercial |
$1,426.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: Riverside University Health System MISP |
$877.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
