|
HC VENIPUNCTURECUTDOWN GT 1YR
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
900501336
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC VENIPUNCTURECUTDOWN GT 1YR
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
900501336
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California EPN |
$48.80
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Senior |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$50.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| 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 |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Senior |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$50.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900510279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900510279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Senior |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.09
|
| Rate for Payer: TriValley Medical Group Senior |
$9.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
906536415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
906536415
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Senior |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.09
|
| Rate for Payer: TriValley Medical Group Senior |
$9.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Senior |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.09
|
| Rate for Payer: TriValley Medical Group Senior |
$9.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
IP
|
$7,293.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$5,469.75 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Cash Price |
$4,011.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,937.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,937.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
OP
|
$7,293.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.98 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,898.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,010.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.28
|
| 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 |
$4,011.15
|
| Rate for Payer: Cash Price |
$4,011.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,740.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,740.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,514.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,514.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,478.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
IP
|
$7,293.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$5,469.75 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Cash Price |
$4,011.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,937.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,937.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
OP
|
$7,293.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,898.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,010.29
|
| 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 |
$3,291.28
|
| 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 |
$4,011.15
|
| Rate for Payer: Cash Price |
$4,011.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,740.45
|
| 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 |
$4,740.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,514.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,514.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,478.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| 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 |
$5,469.75
|
| 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 VENOGRAM EPIDURAL
|
Facility
|
OP
|
$3,109.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$562.73 |
| Max. Negotiated Rate |
$3,291.28 |
| Rate for Payer: Adventist Health Commercial |
$621.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,661.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,135.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.28
|
| 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 |
$1,709.95
|
| Rate for Payer: Cash Price |
$1,709.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,020.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,020.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,924.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,924.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,482.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$2,331.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$785.56
|
| Rate for Payer: TriValley Medical Group Senior |
$785.56
|
| 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 |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
|
IP
|
$3,109.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$562.73 |
| Max. Negotiated Rate |
$2,331.75 |
| Rate for Payer: Adventist Health Commercial |
$621.80
|
| Rate for Payer: Cash Price |
$1,709.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,104.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,104.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.25
|
| Rate for Payer: Multiplan Commercial |
$2,331.75
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
IP
|
$3,108.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$2,331.00 |
| Rate for Payer: Adventist Health Commercial |
$621.60
|
| Rate for Payer: Cash Price |
$1,709.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,104.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,104.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.00
|
| Rate for Payer: Multiplan Commercial |
$2,331.00
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.99 |
| Max. Negotiated Rate |
$2,960.70 |
| Rate for Payer: Adventist Health Commercial |
$362.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$968.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,244.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.70
|
| Rate for Payer: Blue Shield of California Commercial |
$310.51
|
| Rate for Payer: Blue Shield of California EPN |
$249.70
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,177.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,121.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$151.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$864.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,973.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,973.80
|
| 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 |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.97 |
| Max. Negotiated Rate |
$1,359.00 |
| Rate for Payer: Adventist Health Commercial |
$362.40
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,226.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,226.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.00
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
OP
|
$3,108.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.99 |
| Max. Negotiated Rate |
$2,960.70 |
| Rate for Payer: Adventist Health Commercial |
$621.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,661.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,135.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.70
|
| Rate for Payer: Blue Shield of California Commercial |
$310.51
|
| Rate for Payer: Blue Shield of California EPN |
$249.70
|
| Rate for Payer: Cash Price |
$1,709.40
|
| Rate for Payer: Cash Price |
$1,709.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,020.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,020.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,923.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,923.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$151.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,482.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$2,331.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,973.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,973.80
|
| 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 |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$2,960.70 |
| Rate for Payer: Adventist Health Commercial |
$364.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$974.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,253.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.10
|
| Rate for Payer: Blue Shield of California Commercial |
$200.54
|
| Rate for Payer: Blue Shield of California EPN |
$161.27
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,185.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,185.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,129.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,129.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$870.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,973.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,973.80
|
| 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 |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$2,960.70 |
| Rate for Payer: Adventist Health Commercial |
$429.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,147.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,474.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.10
|
| Rate for Payer: Blue Shield of California Commercial |
$200.54
|
| Rate for Payer: Blue Shield of California EPN |
$161.27
|
| Rate for Payer: Cash Price |
$1,180.30
|
| Rate for Payer: Cash Price |
$1,180.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,394.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,394.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,023.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,609.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,973.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,973.80
|
| 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 |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.14 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Adventist Health Commercial |
$364.80
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,234.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.00
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
|
