|
HC VENOGRAM EPIDURAL
|
Facility
OP
|
$3,851.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$497.89 |
| Max. Negotiated Rate |
$3,017.54 |
| Rate for Payer: Adventist Health Commercial |
$770.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$497.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,645.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,732.95
|
| Rate for Payer: Cash Price |
$1,732.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,503.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,503.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,383.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,383.77
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$2,888.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$784.90
|
| Rate for Payer: TriValley Medical Group Senior |
$784.90
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC VENOGRAM EPIDURAL
|
Facility
IP
|
$3,851.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$697.03 |
| Max. Negotiated Rate |
$2,888.25 |
| Rate for Payer: Adventist Health Commercial |
$770.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,645.64
|
| Rate for Payer: Cash Price |
$1,732.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,607.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,607.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.75
|
| Rate for Payer: Multiplan Commercial |
$2,888.25
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$406.16 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$448.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,541.63
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,519.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,519.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$1,683.00
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
IP
|
$5,973.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,081.11 |
| Max. Negotiated Rate |
$4,479.75 |
| Rate for Payer: Adventist Health Commercial |
$1,194.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,103.45
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,043.72
|
| Rate for Payer: Heritage Provider Network Senior |
$4,043.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.25
|
| Rate for Payer: Multiplan Commercial |
$4,479.75
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.36 |
| Max. Negotiated Rate |
$3,801.92 |
| Rate for Payer: Adventist Health Commercial |
$448.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,541.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.70
|
| Rate for Payer: Blue Shield of California Commercial |
$301.46
|
| Rate for Payer: Blue Shield of California EPN |
$171.43
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,458.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,458.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.04
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$146.36
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$1,683.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| 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 |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
OP
|
$5,973.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.36 |
| Max. Negotiated Rate |
$4,479.75 |
| Rate for Payer: Adventist Health Commercial |
$1,194.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,103.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.70
|
| Rate for Payer: Blue Shield of California Commercial |
$301.46
|
| Rate for Payer: Blue Shield of California EPN |
$171.43
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,882.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,882.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,697.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3,697.29
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$146.36
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$4,479.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| 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 |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$3,801.92 |
| Rate for Payer: Adventist Health Commercial |
$796.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,735.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.63
|
| Rate for Payer: Blue Shield of California Commercial |
$194.69
|
| Rate for Payer: Blue Shield of California EPN |
$110.72
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,588.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,464.86
|
| Rate for Payer: Heritage Provider Network Senior |
$2,464.86
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$95.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,986.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| 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 |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$3,801.92 |
| Rate for Payer: Adventist Health Commercial |
$448.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,541.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.63
|
| Rate for Payer: Blue Shield of California Commercial |
$194.69
|
| Rate for Payer: Blue Shield of California EPN |
$110.72
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,458.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,458.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.04
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$95.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$1,683.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| 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 |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$406.16 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$448.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,541.63
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,519.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,519.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$1,683.00
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$720.74 |
| Max. Negotiated Rate |
$2,986.50 |
| Rate for Payer: Adventist Health Commercial |
$796.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,735.63
|
| Rate for Payer: Cash Price |
$1,791.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,695.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.50
|
| Rate for Payer: Multiplan Commercial |
$2,986.50
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
OP
|
$7,502.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$334.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,153.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,876.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,876.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,643.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4,643.74
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$161.49
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,626.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
IP
|
$7,502.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,357.86 |
| Max. Negotiated Rate |
$5,626.50 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,153.87
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,078.85
|
| Rate for Payer: Heritage Provider Network Senior |
$5,078.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.50
|
| Rate for Payer: Multiplan Commercial |
$5,626.50
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
OP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$9,813.75 |
| Rate for Payer: Adventist Health Commercial |
$2,617.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$334.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,989.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,505.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,505.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,099.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8,099.62
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$161.49
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,368.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,271.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$9,813.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
IP
|
$13,085.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,368.38 |
| Max. Negotiated Rate |
$9,813.75 |
| Rate for Payer: Adventist Health Commercial |
$2,617.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,989.40
|
| Rate for Payer: Cash Price |
$5,888.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,858.54
|
| Rate for Payer: Heritage Provider Network Senior |
$8,858.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,368.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,271.25
|
| Rate for Payer: Multiplan Commercial |
$9,813.75
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
OP
|
$2,522.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.68 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$504.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$345.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,732.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,639.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,639.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,561.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,561.12
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$1,891.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,162.59 |
| Max. Negotiated Rate |
$8,961.00 |
| Rate for Payer: Adventist Health Commercial |
$2,389.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,208.28
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,088.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,088.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,162.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,987.00
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.68 |
| Max. Negotiated Rate |
$8,961.00 |
| Rate for Payer: Adventist Health Commercial |
$2,389.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$345.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,208.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,766.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,766.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,395.81
|
| Rate for Payer: Heritage Provider Network Senior |
$7,395.81
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,162.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,987.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$8,961.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
IP
|
$2,522.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$456.48 |
| Max. Negotiated Rate |
$1,891.50 |
| Rate for Payer: Adventist Health Commercial |
$504.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,732.61
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,707.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,707.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.50
|
| Rate for Payer: Multiplan Commercial |
$1,891.50
|
|
|
HC VENOGRAM ORBITAL
|
Facility
IP
|
$5,599.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,013.42 |
| Max. Negotiated Rate |
$4,199.25 |
| Rate for Payer: Adventist Health Commercial |
$1,119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,846.51
|
| Rate for Payer: Cash Price |
$2,519.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,790.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,790.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,399.75
|
| Rate for Payer: Multiplan Commercial |
$4,199.25
|
|
|
HC VENOGRAM ORBITAL
|
Facility
OP
|
$5,599.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$4,199.25 |
| Rate for Payer: Adventist Health Commercial |
$1,119.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$303.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,846.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.63
|
| Rate for Payer: Blue Shield of California Commercial |
$194.69
|
| Rate for Payer: Blue Shield of California EPN |
$110.72
|
| Rate for Payer: Cash Price |
$2,519.55
|
| Rate for Payer: Cash Price |
$2,519.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,639.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,639.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,465.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,465.78
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,399.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$4,199.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$784.90
|
| Rate for Payer: TriValley Medical Group Senior |
$784.90
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
IP
|
$1,059.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.68 |
| Max. Negotiated Rate |
$794.25 |
| Rate for Payer: Adventist Health Commercial |
$211.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$727.53
|
| Rate for Payer: Cash Price |
$476.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$716.94
|
| Rate for Payer: Heritage Provider Network Senior |
$716.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.75
|
| Rate for Payer: Multiplan Commercial |
$794.25
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
OP
|
$1,059.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.68 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$211.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$378.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$727.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$476.55
|
| Rate for Payer: Cash Price |
$476.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$688.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.52
|
| Rate for Payer: Heritage Provider Network Senior |
$655.52
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$794.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
OP
|
$7,067.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.91 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,413.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,855.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,016.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,180.15
|
| Rate for Payer: Cash Price |
$3,180.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,593.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,593.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,374.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,374.47
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,279.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,766.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,300.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
IP
|
$7,067.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,279.13 |
| Max. Negotiated Rate |
$5,300.25 |
| Rate for Payer: Adventist Health Commercial |
$1,413.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,855.03
|
| Rate for Payer: Cash Price |
$3,180.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,784.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,784.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,279.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,766.75
|
| Rate for Payer: Multiplan Commercial |
$5,300.25
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
IP
|
$4,729.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$855.95 |
| Max. Negotiated Rate |
$3,546.75 |
| Rate for Payer: Adventist Health Commercial |
$945.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,248.82
|
| Rate for Payer: Cash Price |
$2,128.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,201.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3,201.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$855.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.25
|
| Rate for Payer: Multiplan Commercial |
$3,546.75
|
|
