|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
IP
|
$6,058.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| 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 VENOGRAM INFERIOR VENACAVA
|
Facility
|
OP
|
$6,058.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| 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 VENOGRAM JUGULAR OR SINUS
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$407.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,258.87
|
| 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 |
$916.65
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.05
|
| 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 |
$1,201.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,260.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,260.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$971.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,527.75
|
| 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 VENOGRAM JUGULAR OR SINUS
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,527.75 |
| Rate for Payer: Adventist Health Commercial |
$407.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,311.83
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,379.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,379.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.25
|
| Rate for Payer: Multiplan Commercial |
$1,527.75
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
IP
|
$4,521.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$818.30 |
| Max. Negotiated Rate |
$3,390.75 |
| Rate for Payer: Adventist Health Commercial |
$904.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,911.52
|
| Rate for Payer: Cash Price |
$2,034.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,060.72
|
| Rate for Payer: Heritage Provider Network Senior |
$3,060.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$818.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.25
|
| Rate for Payer: Multiplan Commercial |
$3,390.75
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
OP
|
$4,521.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$3,390.75 |
| Rate for Payer: Adventist Health Commercial |
$904.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,793.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.94
|
| 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 |
$2,034.45
|
| Rate for Payer: Cash Price |
$2,034.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,938.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,667.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,798.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,798.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,156.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$818.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$3,390.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$806.82
|
| Rate for Payer: TriValley Medical Group Senior |
$806.82
|
| 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 |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.39
|
| 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 |
$384.75
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$555.75
|
| 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 |
$504.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.25
|
| Rate for Payer: Heritage Provider Network Senior |
$529.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$407.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$641.25
|
| 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 VENOGRAM RENAL BILAT
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.62
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.84
|
| Rate for Payer: Heritage Provider Network Senior |
$578.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$641.25
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
|
IP
|
$5,707.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,032.97 |
| Max. Negotiated Rate |
$4,280.25 |
| Rate for Payer: Adventist Health Commercial |
$1,141.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,675.31
|
| Rate for Payer: Cash Price |
$2,568.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,863.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,863.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,032.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.75
|
| Rate for Payer: Multiplan Commercial |
$4,280.25
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
|
OP
|
$5,707.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,032.97 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,141.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,526.93
|
| 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 |
$3,421.36
|
| 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 |
$2,568.15
|
| Rate for Payer: Cash Price |
$2,568.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,709.55
|
| 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 |
$3,367.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,532.63
|
| Rate for Payer: Heritage Provider Network Senior |
$3,532.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,722.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,032.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,280.25
|
| 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 VENOGRAM SUPERIOR VENACAVA
|
Facility
|
IP
|
$3,819.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$691.24 |
| Max. Negotiated Rate |
$2,864.25 |
| Rate for Payer: Adventist Health Commercial |
$763.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,459.44
|
| Rate for Payer: Cash Price |
$1,718.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,585.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,585.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$954.75
|
| Rate for Payer: Multiplan Commercial |
$2,864.25
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
OP
|
$3,819.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$691.24 |
| Max. Negotiated Rate |
$3,404.17 |
| Rate for Payer: Adventist Health Commercial |
$763.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,360.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| 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 |
$1,718.55
|
| Rate for Payer: Cash Price |
$1,718.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,482.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,253.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,363.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,363.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,821.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$954.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,864.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,024.63
|
| Rate for Payer: TriValley Medical Group Senior |
$2,024.63
|
| 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 |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
OP
|
$3,109.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$562.73 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$621.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,921.36
|
| 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 |
$1,399.05
|
| Rate for Payer: Cash Price |
$1,399.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,020.85
|
| 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 |
$1,834.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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 |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,482.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$562.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$2,331.75
|
| 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 VENOGRAM SUP SAG SINUS
|
Facility
|
IP
|
$3,109.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
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: Aetna of CA Non-Gatekeeper |
$2,002.20
|
| Rate for Payer: Cash Price |
$1,399.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,104.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,104.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$562.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.25
|
| Rate for Payer: Multiplan Commercial |
$2,331.75
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$329.85
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$476.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$623.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.73
|
| Rate for Payer: Heritage Provider Network Senior |
$453.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$349.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$513.10
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.05
|
| Rate for Payer: Vantage Medical Group Senior |
$623.05
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$472.05
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$338.25 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.44
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.33
|
| Rate for Payer: Heritage Provider Network Senior |
$305.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$338.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$383.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.17
|
| Rate for Payer: Heritage Provider Network Senior |
$279.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$215.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$315.70
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| 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 |
$383.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Vantage Medical Group Senior |
$383.35
|
|
|
HC VENOUS ACCESS PORT
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,141.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$712.75
|
| Rate for Payer: Blue Shield of California EPN |
$712.75
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$957.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.90
|
| Rate for Payer: Heritage Provider Network Senior |
$820.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$886.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$886.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$886.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$640.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$587.04
|
|
|
HC VENOUS ACCESS PORT
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,095.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,329.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$712.75
|
| Rate for Payer: Blue Shield of California EPN |
$712.75
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,507.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,507.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.90
|
| Rate for Payer: Heritage Provider Network Senior |
$820.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$886.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$886.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$886.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,241.10
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$640.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$587.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.24
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$720.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$816.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$816.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.24
|
| Rate for Payer: Heritage Provider Network Senior |
$594.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$457.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| 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 |
$816.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$816.00
|
| Rate for Payer: Vantage Medical Group Senior |
$816.00
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,211.30 |
| Max. Negotiated Rate |
$13,306.50 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,425.85
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,011.33
|
| Rate for Payer: Heritage Provider Network Senior |
$12,011.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,211.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,435.50
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,211.30 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,964.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| 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 |
$7,983.90
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Cash Price |
$7,983.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,532.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,982.30
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,211.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,435.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
IP
|
$18,970.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,433.57 |
| Max. Negotiated Rate |
$14,227.50 |
| Rate for Payer: Adventist Health Commercial |
$3,794.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,216.68
|
| Rate for Payer: Cash Price |
$8,536.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,842.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12,842.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,433.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,742.50
|
| Rate for Payer: Multiplan Commercial |
$14,227.50
|
|
