|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$355.48 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,264.82
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,329.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,329.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$355.48 |
| Max. Negotiated Rate |
$3,404.04 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,213.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.04
|
| 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 |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,276.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,669.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,669.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,158.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,215.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,215.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$936.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,374.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$982.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,669.40
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$489.79 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$541.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,742.66
|
| Rate for Payer: Cash Price |
$1,217.70
|
| Rate for Payer: Cash Price |
$1,217.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$2,029.50
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$2,706.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$489.79 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$541.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,672.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,300.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,488.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,029.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,217.70
|
| Rate for Payer: Cash Price |
$1,217.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,300.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,300.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,300.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,596.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,675.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,675.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,290.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,894.20
|
| Rate for Payer: Multiplan Commercial |
$2,029.50
|
| 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 |
$2,300.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,300.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,300.10
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,747.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,577.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,905.22
|
| 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 Foundation Hospitals 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 UNILAT
|
Facility
|
OP
|
$6,058.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,096.50 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,211.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,743.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.17
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,574.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,889.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,096.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,514.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,543.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,901.35
|
| 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 Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$13,321.78
|
| 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 Foundation Hospitals 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 |
$918.00 |
| Max. Negotiated Rate |
$17,583.10 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,783.95
|
| 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 |
$6,245.00
|
| 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: 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$9,867.22
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,747.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,577.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,905.22
|
| 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 Foundation Hospitals 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
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,747.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.17
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,577.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,905.22
|
| 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 Foundation Hospitals 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 INTERNAL MAMMARY
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$617.21 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$682.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,107.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.17
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,011.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,626.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$617.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$2,557.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,196.04
|
| 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 Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$3,905.22
|
| 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 Foundation Hospitals 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
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,747.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,577.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
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: Aetna of CA Non-Gatekeeper |
$3,905.22
|
| 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 Foundation Hospitals 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 UNILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,747.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.10
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,577.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$380.10 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.40
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,421.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$380.10 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,297.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.96
|
| 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 |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,365.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,239.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,299.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,299.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,001.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
OP
|
$8,560.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,549.36 |
| Max. Negotiated Rate |
$10,735.29 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,290.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| 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 |
$3,852.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,564.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,050.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,298.64
|
| Rate for Payer: Heritage Provider Network Senior |
$5,298.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,083.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,549.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$6,420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,156.86
|
| Rate for Payer: TriValley Medical Group Senior |
$7,156.86
|
| 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 |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
IP
|
$8,560.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,549.36 |
| Max. Negotiated Rate |
$6,420.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,512.64
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,795.12
|
| Rate for Payer: Heritage Provider Network Senior |
$5,795.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,549.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,140.00
|
| Rate for Payer: Multiplan Commercial |
$6,420.00
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$9,096.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,857.82
|
| Rate for Payer: Cash Price |
$4,093.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,157.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,157.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,646.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,274.00
|
| Rate for Payer: Multiplan Commercial |
$6,822.00
|
|
