|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.81 |
| Max. Negotiated Rate |
$8,961.00 |
| Rate for Payer: Adventist Health Commercial |
$2,389.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$396.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,208.28
|
| 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 HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,766.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,766.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,395.81
|
| Rate for Payer: Heritage Provider Network Senior |
$7,395.81
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,162.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,987.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| 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 INTERNAL MAMMARY
|
Facility
|
OP
|
$4,223.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.81 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$844.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$396.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,901.20
|
| 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 HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,900.35
|
| Rate for Payer: Cash Price |
$1,900.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,744.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,744.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,614.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2,614.04
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$764.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$3,167.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| 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 INTERNAL MAMMARY
|
Facility
|
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,162.59 |
| Max. Negotiated Rate |
$8,961.00 |
| Rate for Payer: Adventist Health Commercial |
$2,389.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,208.28
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,088.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,088.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,162.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,987.00
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$209.88 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$361.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| 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 HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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
|
$7,509.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$11,597.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$209.88 |
| Max. Negotiated Rate |
$8,697.75 |
| Rate for Payer: Adventist Health Commercial |
$2,319.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$361.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,967.14
|
| 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 HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,538.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,538.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,178.54
|
| Rate for Payer: Heritage Provider Network Senior |
$7,178.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,899.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$8,697.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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 |
$2,099.06 |
| Max. Negotiated Rate |
$8,697.75 |
| Rate for Payer: Adventist Health Commercial |
$2,319.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,967.14
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,851.17
|
| Rate for Payer: Heritage Provider Network Senior |
$7,851.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,899.25
|
| Rate for Payer: Multiplan Commercial |
$8,697.75
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$185.69 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| 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 HMO/PPO |
$3,000.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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
|
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$185.69 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,546.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,311.20
|
| 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 HMO/PPO |
$3,000.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,025.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,025.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,785.49
|
| Rate for Payer: Heritage Provider Network Senior |
$4,785.49
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,399.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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
|
$7,509.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,399.31 |
| Max. Negotiated Rate |
$5,798.25 |
| Rate for Payer: Adventist Health Commercial |
$1,546.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,311.20
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,233.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5,233.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,399.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.75
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$470.78 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.89
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,760.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,760.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$372.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.89
|
| 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 HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,690.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,690.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,610.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,610.02
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| 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 SPINAL
|
Facility
|
OP
|
$10,601.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$329.72 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,120.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$394.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,282.89
|
| 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 HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$4,770.45
|
| Rate for Payer: Cash Price |
$4,770.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,890.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,890.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,562.02
|
| Rate for Payer: Heritage Provider Network Senior |
$6,562.02
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$7,950.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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 SPINAL
|
Facility
|
IP
|
$10,601.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,918.78 |
| Max. Negotiated Rate |
$7,950.75 |
| Rate for Payer: Adventist Health Commercial |
$2,120.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,282.89
|
| Rate for Payer: Cash Price |
$4,770.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,176.88
|
| Rate for Payer: Heritage Provider Network Senior |
$7,176.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.25
|
| Rate for Payer: Multiplan Commercial |
$7,950.75
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$11,264.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,252.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$389.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,738.37
|
| 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 HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,321.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,321.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,972.42
|
| Rate for Payer: Heritage Provider Network Senior |
$6,972.42
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,816.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$8,448.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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
|
$11,264.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,038.78 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Adventist Health Commercial |
$2,252.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,738.37
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,625.73
|
| Rate for Payer: Heritage Provider Network Senior |
$7,625.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,816.00
|
| Rate for Payer: Multiplan Commercial |
$8,448.00
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,552.46 |
| Max. Negotiated Rate |
$10,576.50 |
| Rate for Payer: Adventist Health Commercial |
$2,820.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,688.07
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,547.05
|
| Rate for Payer: Heritage Provider Network Senior |
$9,547.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.50
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,820.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$389.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,688.07
|
| 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 HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,166.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,166.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,729.14
|
| Rate for Payer: Heritage Provider Network Senior |
$8,729.14
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| 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 ANGIOJET PUMP SET
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$481.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Blue Shield of California Commercial |
$558.90
|
| Rate for Payer: Blue Shield of California EPN |
$528.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Senior |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| 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 |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
|
|
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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,006.02
|
| Rate for Payer: Blue Shield of California EPN |
$950.94
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Senior |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.06
|
| Rate for Payer: Heritage Provider Network Senior |
$750.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
| 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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,411.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,019.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,825.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,725.78
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,352.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Senior |
$2,499.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,881.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,361.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,361.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,071.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.25
|
| 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,411.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,019.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,352.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,587.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,990.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,990.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,071.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.25
|
|
