|
HC ULTRASOUND CHEST
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.33 |
| Max. Negotiated Rate |
$1,475.60 |
| Rate for Payer: Adventist Health Commercial |
$347.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,138.64
|
| 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 |
$1,066.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.43
|
| Rate for Payer: Blue Shield of California EPN |
$701.34
|
| Rate for Payer: Cash Price |
$954.80
|
| Rate for Payer: Cash Price |
$954.80
|
| Rate for Payer: Cigna of CA HMO |
$1,111.04
|
| Rate for Payer: Cigna of CA PPO |
$1,284.64
|
| 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 |
$1,475.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,041.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,157.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.64
|
| 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 |
$1,388.80
|
| Rate for Payer: Networks By Design Commercial |
$1,128.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,475.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,041.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,041.60
|
| 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: 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 CHEST
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$1,475.60 |
| Rate for Payer: Adventist Health Commercial |
$347.20
|
| Rate for Payer: Cash Price |
$954.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$694.40
|
| Rate for Payer: EPIC Health Plan Senior |
$694.40
|
| Rate for Payer: Galaxy Health WC |
$1,475.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,041.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,157.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.64
|
| Rate for Payer: Multiplan Commercial |
$1,388.80
|
| Rate for Payer: Networks By Design Commercial |
$1,128.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,475.60
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
IP
|
$2,134.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$1,813.90 |
| Rate for Payer: Adventist Health Commercial |
$426.80
|
| Rate for Payer: Cash Price |
$1,173.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$853.60
|
| Rate for Payer: EPIC Health Plan Senior |
$853.60
|
| Rate for Payer: Galaxy Health WC |
$1,813.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,280.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,423.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,320.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.16
|
| Rate for Payer: Multiplan Commercial |
$1,707.20
|
| Rate for Payer: Networks By Design Commercial |
$1,387.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,813.90
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
OP
|
$2,134.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.04 |
| Max. Negotiated Rate |
$1,813.90 |
| Rate for Payer: Adventist Health Commercial |
$426.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,399.69
|
| 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 |
$1,310.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.01
|
| Rate for Payer: Blue Shield of California EPN |
$862.14
|
| Rate for Payer: Cash Price |
$1,173.70
|
| Rate for Payer: Cash Price |
$1,173.70
|
| Rate for Payer: Cigna of CA HMO |
$1,365.76
|
| Rate for Payer: Cigna of CA PPO |
$1,579.16
|
| 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 |
$1,813.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,280.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,423.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.16
|
| 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 |
$1,707.20
|
| Rate for Payer: Networks By Design Commercial |
$1,387.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,813.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,280.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,280.40
|
| 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 OB DETAILED ADDL FETUS
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
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 ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.07 |
| 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 |
$302.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.02
|
| 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 ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
OP
|
$2,154.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.58 |
| Max. Negotiated Rate |
$1,830.90 |
| Rate for Payer: Adventist Health Commercial |
$430.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,412.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,322.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.25
|
| Rate for Payer: Blue Shield of California EPN |
$870.22
|
| Rate for Payer: Cash Price |
$1,184.70
|
| Rate for Payer: Cash Price |
$1,184.70
|
| Rate for Payer: Cigna of CA HMO |
$1,378.56
|
| Rate for Payer: Cigna of CA PPO |
$1,593.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,830.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,292.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$266.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,436.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$516.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,723.20
|
| Rate for Payer: Networks By Design Commercial |
$1,400.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,830.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,292.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,292.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
IP
|
$2,154.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$430.80 |
| Max. Negotiated Rate |
$1,830.90 |
| Rate for Payer: Adventist Health Commercial |
$430.80
|
| Rate for Payer: Cash Price |
$1,184.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$861.60
|
| Rate for Payer: EPIC Health Plan Senior |
$861.60
|
| Rate for Payer: Galaxy Health WC |
$1,830.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,292.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,436.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$820.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,333.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$516.96
|
| Rate for Payer: Multiplan Commercial |
$1,723.20
|
| Rate for Payer: Networks By Design Commercial |
$1,400.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,830.90
|
|
|
HC ULTRASOUND OB GT 14 WK ADDL FETUS
|
Facility
|
IP
|
$1,687.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
906601302
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$1,433.95 |
| Rate for Payer: Adventist Health Commercial |
$337.40
|
| Rate for Payer: Cash Price |
$927.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.80
|
| Rate for Payer: EPIC Health Plan Senior |
$674.80
|
| Rate for Payer: Galaxy Health WC |
$1,433.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,044.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.88
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: Networks By Design Commercial |
$1,096.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,433.95
|
|
|
HC ULTRASOUND OB GT 14 WK ADDL FETUS
|
Facility
|
OP
|
$1,687.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
906601302
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$138.36 |
| Max. Negotiated Rate |
$1,433.95 |
| Rate for Payer: Adventist Health Commercial |
$337.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,106.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,433.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$927.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,265.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,035.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,032.44
|
| Rate for Payer: Blue Shield of California EPN |
$681.55
|
| Rate for Payer: Cash Price |
$927.85
|
| Rate for Payer: Cash Price |
$927.85
|
| Rate for Payer: Cigna of CA HMO |
$1,079.68
|
| Rate for Payer: Cigna of CA PPO |
$1,248.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,433.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,433.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,433.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.80
|
| Rate for Payer: EPIC Health Plan Senior |
$674.80
|
| Rate for Payer: Galaxy Health WC |
$1,433.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,044.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,180.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,180.90
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: Networks By Design Commercial |
$1,096.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,433.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,012.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,012.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,433.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,433.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,433.95
|
|
|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Adventist Health Commercial |
$400.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$800.00
|
| Rate for Payer: Galaxy Health WC |
$1,700.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,238.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Multiplan Commercial |
$1,600.00
|
| Rate for Payer: Networks By Design Commercial |
$1,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.00
|
|
|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Adventist Health Commercial |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,311.80
|
| 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 |
$1,228.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,224.00
|
| Rate for Payer: Blue Shield of California EPN |
$808.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna of CA HMO |
$1,280.00
|
| Rate for Payer: Cigna of CA PPO |
$1,480.00
|
| 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 |
$1,700.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| 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 |
$1,600.00
|
| Rate for Payer: Networks By Design Commercial |
$1,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,200.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,200.00
|
| 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 ULTRASOUND PELVIC
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,165.80 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,577.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.52
|
| Rate for Payer: Multiplan Commercial |
$2,038.40
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC ULTRASOUND PELVIC
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$2,165.80 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,671.23
|
| 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 |
$1,564.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,559.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,029.39
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| 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 |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.52
|
| 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 |
$2,038.40
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.80
|
| 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 RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$944.00
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$899.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,460.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
|
|
HC ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,547.92
|
| 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 |
$1,449.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,444.32
|
| Rate for Payer: Blue Shield of California EPN |
$953.44
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| 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 |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| 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 |
$1,888.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| 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 ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$2,033.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$406.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Adventist Health Commercial |
$406.60
|
| Rate for Payer: Cash Price |
$1,118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$813.20
|
| Rate for Payer: Galaxy Health WC |
$1,728.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,219.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.92
|
| Rate for Payer: Multiplan Commercial |
$1,626.40
|
| Rate for Payer: Networks By Design Commercial |
$1,321.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.05
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$2,033.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Adventist Health Commercial |
$406.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,333.44
|
| 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 |
$1,248.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,244.20
|
| Rate for Payer: Blue Shield of California EPN |
$821.33
|
| Rate for Payer: Cash Price |
$1,118.15
|
| Rate for Payer: Cash Price |
$1,118.15
|
| Rate for Payer: Cigna of CA HMO |
$1,301.12
|
| Rate for Payer: Cigna of CA PPO |
$1,504.42
|
| 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 |
$1,728.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,219.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.92
|
| 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 |
$1,626.40
|
| Rate for Payer: Networks By Design Commercial |
$1,321.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,219.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,219.80
|
| 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 TRANSP KIDNEY W/DOPPLER
|
Facility
|
IP
|
$2,684.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$536.80 |
| Max. Negotiated Rate |
$2,281.40 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Cash Price |
$1,476.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,073.60
|
| Rate for Payer: Galaxy Health WC |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,661.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.16
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,281.40 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,760.44
|
| 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 |
$1,648.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,642.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,084.34
|
| Rate for Payer: Cash Price |
$1,476.20
|
| Rate for Payer: Cash Price |
$1,476.20
|
| Rate for Payer: Cigna of CA HMO |
$1,717.76
|
| Rate for Payer: Cigna of CA PPO |
$1,986.16
|
| 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 |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.16
|
| 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 |
$2,147.20
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,610.40
|
| 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 TRANSVAGINAL OB
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.11
|
| 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 |
$963.52
|
| Rate for Payer: Blue Shield of California Commercial |
$960.23
|
| Rate for Payer: Blue Shield of California EPN |
$633.88
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| 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 |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| 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 |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| 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: 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 TRANSVAGINAL OB
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$971.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Cigna of CA HMO |
$146.56
|
| Rate for Payer: Cigna of CA PPO |
$169.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Senior |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.30
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Senior |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
