|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$1,201.05 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$867.72
|
| Rate for Payer: Blue Shield of California Commercial |
$864.76
|
| Rate for Payer: Blue Shield of California EPN |
$570.85
|
| Rate for Payer: Cash Price |
$777.15
|
| Rate for Payer: Cigna of CA HMO |
$904.32
|
| Rate for Payer: Cigna of CA PPO |
$1,045.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.20
|
| Rate for Payer: EPIC Health Plan Senior |
$565.20
|
| Rate for Payer: Galaxy Health WC |
$1,201.05
|
| Rate for Payer: Global Benefits Group Commercial |
$847.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$942.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.10
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: Networks By Design Commercial |
$918.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$706.50
|
| Rate for Payer: United Healthcare All Other HMO |
$706.50
|
| Rate for Payer: United Healthcare HMO Rider |
$706.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$706.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.05
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$864.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$559.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$624.54
|
| Rate for Payer: Blue Shield of California Commercial |
$622.40
|
| Rate for Payer: Blue Shield of California EPN |
$410.87
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$864.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$864.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$629.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$711.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$711.90
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$508.50
|
| Rate for Payer: United Healthcare All Other HMO |
$508.50
|
| Rate for Payer: United Healthcare HMO Rider |
$508.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$864.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.45
|
| Rate for Payer: Vantage Medical Group Senior |
$864.45
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$629.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Cash Price |
$602.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$678.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.34
|
| Rate for Payer: Blue Shield of California Commercial |
$670.75
|
| Rate for Payer: Blue Shield of California EPN |
$442.78
|
| Rate for Payer: Cash Price |
$602.80
|
| Rate for Payer: Cash Price |
$602.80
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.97 |
| Max. Negotiated Rate |
$1,172.15 |
| Rate for Payer: Adventist Health Commercial |
$275.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$904.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$846.84
|
| Rate for Payer: Blue Shield of California Commercial |
$843.95
|
| Rate for Payer: Blue Shield of California EPN |
$557.12
|
| Rate for Payer: Cash Price |
$758.45
|
| Rate for Payer: Cash Price |
$758.45
|
| Rate for Payer: Cigna of CA HMO |
$882.56
|
| Rate for Payer: Cigna of CA PPO |
$1,020.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,172.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,172.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Senior |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$965.30
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$1,172.15 |
| Rate for Payer: Adventist Health Commercial |
$275.80
|
| Rate for Payer: Cash Price |
$758.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Senior |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,555.50 |
| Rate for Payer: Adventist Health Commercial |
$366.00
|
| Rate for Payer: Cash Price |
$1,006.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.00
|
| Rate for Payer: EPIC Health Plan Senior |
$732.00
|
| Rate for Payer: Galaxy Health WC |
$1,555.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,220.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$697.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.20
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: Networks By Design Commercial |
$1,189.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,555.50
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
OP
|
$1,830.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$1,555.50 |
| Rate for Payer: Adventist Health Commercial |
$366.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,200.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,123.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.96
|
| Rate for Payer: Blue Shield of California EPN |
$739.32
|
| Rate for Payer: Cash Price |
$1,006.50
|
| Rate for Payer: Cash Price |
$1,006.50
|
| Rate for Payer: Cigna of CA HMO |
$1,171.20
|
| Rate for Payer: Cigna of CA PPO |
$1,354.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,555.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,220.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: Networks By Design Commercial |
$1,189.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,555.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,098.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,750.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,467.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,639.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,633.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.28
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: Cigna of CA HMO |
$1,708.16
|
| Rate for Payer: Cigna of CA PPO |
$1,975.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,268.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,268.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,780.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,652.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,868.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,868.30
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,601.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,601.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,334.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,334.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,334.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,334.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,268.65
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,780.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,652.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,780.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,652.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,750.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,467.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,639.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,633.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,078.28
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: Cash Price |
$1,467.95
|
| Rate for Payer: Cigna of CA HMO |
$1,708.16
|
| Rate for Payer: Cigna of CA PPO |
$1,975.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,268.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,268.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,780.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,652.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,868.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,868.30
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,601.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,601.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,268.65
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
OP
|
$2,821.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,397.85 |
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: Adventist Health Commercial |
$564.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,850.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,732.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,726.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,139.68
|
| Rate for Payer: Cash Price |
$1,551.55
|
| Rate for Payer: Cash Price |
$1,551.55
|
| Rate for Payer: Cigna of CA HMO |
$1,805.44
|
| Rate for Payer: Cigna of CA PPO |
$2,087.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,397.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,692.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,881.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$2,256.80
|
| Rate for Payer: Networks By Design Commercial |
$1,833.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,397.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,692.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,692.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
IP
|
$2,821.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$564.20 |
| Max. Negotiated Rate |
$2,397.85 |
| Rate for Payer: Adventist Health Commercial |
$564.20
|
| Rate for Payer: Cash Price |
$1,551.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,128.40
|
| Rate for Payer: Galaxy Health WC |
$2,397.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,692.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,881.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,746.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.04
|
| Rate for Payer: Multiplan Commercial |
$2,256.80
|
| Rate for Payer: Networks By Design Commercial |
$1,833.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,397.85
|
|
|
HC ULTRASOUND BREAST COMPLETE
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
906676641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.04
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
|
|
HC ULTRASOUND BREAST COMPLETE
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
906676641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.83
|
| Rate for Payer: Blue Shield of California Commercial |
$227.05
|
| Rate for Payer: Blue Shield of California EPN |
$149.88
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Cigna of CA HMO |
$237.44
|
| Rate for Payer: Cigna of CA PPO |
$274.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$161.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.66
|
| Rate for Payer: United Healthcare All Other HMO |
$234.66
|
| Rate for Payer: United Healthcare HMO Rider |
$234.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ULTRASOUND BREAST LIMITED
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
906676642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC ULTRASOUND BREAST LIMITED
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
906676642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$234.66 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.22
|
| Rate for Payer: Blue Shield of California Commercial |
$113.83
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.66
|
| Rate for Payer: United Healthcare All Other HMO |
$234.66
|
| Rate for Payer: United Healthcare HMO Rider |
$234.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
