|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$616.55
|
| 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 |
$577.25
|
| Rate for Payer: Blue Shield of California Commercial |
$575.28
|
| Rate for Payer: Blue Shield of California EPN |
$379.76
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna of CA HMO |
$601.60
|
| Rate for Payer: Cigna of CA PPO |
$695.60
|
| 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 |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| 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 |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.03
|
| Rate for Payer: United Healthcare All Other HMO |
$288.03
|
| Rate for Payer: United Healthcare HMO Rider |
$288.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.03
|
| 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 US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$616.55
|
| 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 |
$577.25
|
| Rate for Payer: Blue Shield of California Commercial |
$575.28
|
| Rate for Payer: Blue Shield of California EPN |
$379.76
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna of CA HMO |
$601.60
|
| Rate for Payer: Cigna of CA PPO |
$695.60
|
| 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 |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| 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 |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.03
|
| Rate for Payer: United Healthcare All Other HMO |
$288.03
|
| Rate for Payer: United Healthcare HMO Rider |
$288.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.03
|
| 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 US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Adventist Health Commercial |
$188.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$376.00
|
| Rate for Payer: Galaxy Health WC |
$799.00
|
| Rate for Payer: Global Benefits Group Commercial |
$564.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.60
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Networks By Design Commercial |
$611.00
|
| Rate for Payer: Prime Health Services Commercial |
$799.00
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$400.35 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.53 |
| Max. Negotiated Rate |
$400.35 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.24
|
| Rate for Payer: Blue Shield of California Commercial |
$288.25
|
| Rate for Payer: Blue Shield of California EPN |
$190.28
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cigna of CA HMO |
$301.44
|
| Rate for Payer: Cigna of CA PPO |
$348.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$400.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$400.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$329.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$329.70
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.50
|
| Rate for Payer: United Healthcare All Other HMO |
$235.50
|
| Rate for Payer: United Healthcare HMO Rider |
$235.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.35
|
| Rate for Payer: Vantage Medical Group Senior |
$400.35
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
915355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
905355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
905355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$685.68 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$1,171.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,654.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,108.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,388.50
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,428.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,428.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,919.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,999.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,999.90
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,428.45
|
|
|
HC USER ADJUSTABLE HEEL HEIGHT
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT L5990
|
| Hospital Charge Code |
915355990
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$685.68 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$1,171.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,571.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,142.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,654.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,108.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,388.50
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,999.90
|
| Rate for Payer: Cigna of CA PPO |
$1,999.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,428.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,428.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,919.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,171.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,999.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,999.90
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,043.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,021.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,428.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,428.45
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$961.07
|
| Rate for Payer: Blue Shield of California Commercial |
$957.78
|
| Rate for Payer: Blue Shield of California EPN |
$632.26
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.50
|
| Rate for Payer: United Healthcare All Other HMO |
$782.50
|
| Rate for Payer: United Healthcare HMO Rider |
$782.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$894.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$830.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$879.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$823.51
|
| Rate for Payer: Blue Shield of California Commercial |
$820.69
|
| Rate for Payer: Blue Shield of California EPN |
$541.76
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cigna of CA HMO |
$858.24
|
| Rate for Payer: Cigna of CA PPO |
$992.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,139.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$894.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$830.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$938.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$938.70
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.50
|
| Rate for Payer: United Healthcare All Other HMO |
$670.50
|
| Rate for Payer: United Healthcare HMO Rider |
$670.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.85
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$879.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$823.51
|
| Rate for Payer: Blue Shield of California Commercial |
$820.69
|
| Rate for Payer: Blue Shield of California EPN |
$541.76
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cigna of CA HMO |
$858.24
|
| Rate for Payer: Cigna of CA PPO |
$992.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,139.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$894.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$830.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$938.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$938.70
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.50
|
| Rate for Payer: United Healthcare All Other HMO |
$670.50
|
| Rate for Payer: United Healthcare HMO Rider |
$670.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.85
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$1,139.85 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$536.40
|
| Rate for Payer: Galaxy Health WC |
$1,139.85
|
| Rate for Payer: Global Benefits Group Commercial |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$894.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$830.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.84
|
| Rate for Payer: Multiplan Commercial |
$1,072.80
|
| Rate for Payer: Networks By Design Commercial |
$871.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.85
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$961.07
|
| Rate for Payer: Blue Shield of California Commercial |
$957.78
|
| Rate for Payer: Blue Shield of California EPN |
$632.26
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.50
|
| Rate for Payer: United Healthcare All Other HMO |
$782.50
|
| Rate for Payer: United Healthcare HMO Rider |
$782.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.00 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$1,330.25 |
| Rate for Payer: Adventist Health Commercial |
$313.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$961.07
|
| Rate for Payer: Blue Shield of California Commercial |
$957.78
|
| Rate for Payer: Blue Shield of California EPN |
$632.26
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cash Price |
$704.25
|
| Rate for Payer: Cigna of CA HMO |
$1,001.60
|
| Rate for Payer: Cigna of CA PPO |
$1,158.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,330.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,330.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$626.00
|
| Rate for Payer: Galaxy Health WC |
$1,330.25
|
| Rate for Payer: Global Benefits Group Commercial |
$939.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,095.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,095.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Networks By Design Commercial |
$1,017.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,330.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.50
|
| Rate for Payer: United Healthcare All Other HMO |
$782.50
|
| Rate for Payer: United Healthcare HMO Rider |
$782.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,330.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,330.25
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.77 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$724.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.97
|
| Rate for Payer: Blue Shield of California Commercial |
$675.65
|
| Rate for Payer: Blue Shield of California EPN |
$446.02
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna of CA HMO |
$706.56
|
| Rate for Payer: Cigna of CA PPO |
$816.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$938.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.60
|
| Rate for Payer: EPIC Health Plan Senior |
$441.60
|
| Rate for Payer: Galaxy Health WC |
$938.40
|
| Rate for Payer: Global Benefits Group Commercial |
$662.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$736.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$772.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$772.80
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Networks By Design Commercial |
$717.60
|
| Rate for Payer: Prime Health Services Commercial |
$938.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$662.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$662.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Other HMO |
$552.00
|
| Rate for Payer: United Healthcare HMO Rider |
$552.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.40
|
| Rate for Payer: Vantage Medical Group Senior |
$938.40
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.60
|
| Rate for Payer: EPIC Health Plan Senior |
$441.60
|
| Rate for Payer: Galaxy Health WC |
$938.40
|
| Rate for Payer: Global Benefits Group Commercial |
$662.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$736.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.96
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Networks By Design Commercial |
$717.60
|
| Rate for Payer: Prime Health Services Commercial |
$938.40
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,662.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,556.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,551.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,024.14
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
