|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,029.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$75.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$605.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,080.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,665.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,271.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,574.65
|
| Rate for Payer: Dignity Health Senior |
$2,574.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,968.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,874.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,874.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,444.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,120.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,120.30
|
| Rate for Payer: Multiplan Commercial |
$2,271.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,574.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,574.65
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$3,029.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$548.25 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$605.80
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.25
|
| Rate for Payer: Multiplan Commercial |
$2,271.75
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,105.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,105.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$250.76 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,241.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,165.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,941.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,753.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,753.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
IP
|
$6,058.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,096.50 |
| Max. Negotiated Rate |
$4,543.50 |
| Rate for Payer: Adventist Health Commercial |
$1,211.60
|
| Rate for Payer: Cash Price |
$2,726.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,101.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,101.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,096.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,514.50
|
| Rate for Payer: Multiplan Commercial |
$4,543.50
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
OP
|
$6,058.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$225.94 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,211.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,238.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,161.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,726.10
|
| Rate for Payer: Cash Price |
$2,726.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,937.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,937.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,749.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,749.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,889.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,096.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,514.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,543.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,744.17 |
| Max. Negotiated Rate |
$15,514.50 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,004.42
|
| Rate for Payer: Heritage Provider Network Senior |
$14,004.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,744.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,171.50
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,583.10 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,211.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,514.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,445.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,583.10
|
| Rate for Payer: Dignity Health Senior |
$17,583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,804.63
|
| Rate for Payer: Heritage Provider Network Senior |
$12,804.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,867.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,744.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,171.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,480.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,480.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$17,583.10
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$12,479.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,258.70 |
| Max. Negotiated Rate |
$9,359.25 |
| Rate for Payer: Adventist Health Commercial |
$2,495.80
|
| Rate for Payer: Cash Price |
$5,615.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,448.28
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,119.75
|
| Rate for Payer: Multiplan Commercial |
$9,359.25
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$238.12 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,241.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,165.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,941.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,753.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,753.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$12,479.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$238.12 |
| Max. Negotiated Rate |
$9,359.25 |
| Rate for Payer: Adventist Health Commercial |
$2,495.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,670.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,573.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$5,615.55
|
| Rate for Payer: Cash Price |
$5,615.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,111.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,111.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,724.50
|
| Rate for Payer: Heritage Provider Network Senior |
$7,724.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,119.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$9,359.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,105.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,105.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,105.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,105.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$10,718.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,939.96 |
| Max. Negotiated Rate |
$8,038.50 |
| Rate for Payer: Adventist Health Commercial |
$2,143.60
|
| Rate for Payer: Cash Price |
$4,823.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,256.09
|
| Rate for Payer: Heritage Provider Network Senior |
$7,256.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,939.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,679.50
|
| Rate for Payer: Multiplan Commercial |
$8,038.50
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$220.55 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,241.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,165.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,941.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,753.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,753.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$10,718.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$220.55 |
| Max. Negotiated Rate |
$8,038.50 |
| Rate for Payer: Adventist Health Commercial |
$2,143.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,728.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,363.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$4,823.10
|
| Rate for Payer: Cash Price |
$4,823.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,966.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,966.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,634.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6,634.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,112.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,939.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,679.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$8,038.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$235.53 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$682.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,822.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,342.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,216.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,216.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,110.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,110.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,626.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$2,557.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$617.21 |
| Max. Negotiated Rate |
$2,557.50 |
| Rate for Payer: Adventist Health Commercial |
$682.00
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,308.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,308.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.50
|
| Rate for Payer: Multiplan Commercial |
$2,557.50
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$11,351.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$235.53 |
| Max. Negotiated Rate |
$8,513.25 |
| Rate for Payer: Adventist Health Commercial |
$2,270.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,067.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,798.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,378.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,378.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,026.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7,026.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,414.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$11,351.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,054.53 |
| Max. Negotiated Rate |
$8,513.25 |
| Rate for Payer: Adventist Health Commercial |
$2,270.20
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,684.63
|
| Rate for Payer: Heritage Provider Network Senior |
$7,684.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.75
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$11,017.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$217.95 |
| Max. Negotiated Rate |
$8,262.75 |
| Rate for Payer: Adventist Health Commercial |
$2,203.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,888.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,568.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$4,957.65
|
| Rate for Payer: Cash Price |
$4,957.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,161.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,161.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,819.52
|
| Rate for Payer: Heritage Provider Network Senior |
$6,819.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,255.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,994.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,754.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$8,262.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,105.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,105.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$11,017.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,994.08 |
| Max. Negotiated Rate |
$8,262.75 |
| Rate for Payer: Adventist Health Commercial |
$2,203.40
|
| Rate for Payer: Cash Price |
$4,957.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,458.51
|
| Rate for Payer: Heritage Provider Network Senior |
$7,458.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,994.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,754.25
|
| Rate for Payer: Multiplan Commercial |
$8,262.75
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$217.95 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,241.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,165.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,941.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,753.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,753.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,344.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,468.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,925.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,045.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,773.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,773.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,545.94
|
| Rate for Payer: Heritage Provider Network Senior |
$4,545.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$192.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,503.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,329.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
