|
HC URINE CHEMISTRY SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.21
|
| Rate for Payer: Blue Shield of California Commercial |
$58.20
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.21
|
| Rate for Payer: Blue Shield of California Commercial |
$58.20
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE COLL KIT W/5FR CATH
|
Facility
|
OP
|
$219.73
|
|
| Hospital Charge Code |
901698695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$186.77 |
| Rate for Payer: Adventist Health Commercial |
$43.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.94
|
| Rate for Payer: Cash Price |
$120.85
|
| Rate for Payer: Cigna of CA HMO |
$140.63
|
| Rate for Payer: Cigna of CA PPO |
$162.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.89
|
| Rate for Payer: EPIC Health Plan Senior |
$87.89
|
| Rate for Payer: Galaxy Health WC |
$186.77
|
| Rate for Payer: Global Benefits Group Commercial |
$131.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$175.78
|
| Rate for Payer: Networks By Design Commercial |
$142.82
|
| Rate for Payer: Prime Health Services Commercial |
$186.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.86
|
| Rate for Payer: United Healthcare All Other HMO |
$109.86
|
| Rate for Payer: United Healthcare HMO Rider |
$109.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.77
|
| Rate for Payer: Vantage Medical Group Senior |
$186.77
|
|
|
HC URINE COLL KIT W/5FR CATH
|
Facility
|
IP
|
$219.73
|
|
| Hospital Charge Code |
901698695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$186.77 |
| Rate for Payer: Adventist Health Commercial |
$43.95
|
| Rate for Payer: Cash Price |
$120.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.89
|
| Rate for Payer: EPIC Health Plan Senior |
$87.89
|
| Rate for Payer: Galaxy Health WC |
$186.77
|
| Rate for Payer: Global Benefits Group Commercial |
$131.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.74
|
| Rate for Payer: Multiplan Commercial |
$175.78
|
| Rate for Payer: Networks By Design Commercial |
$142.82
|
| Rate for Payer: Prime Health Services Commercial |
$186.77
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.32 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.20
|
| Rate for Payer: Blue Shield of California Commercial |
$668.92
|
| Rate for Payer: Blue Shield of California EPN |
$441.57
|
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.32
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
HC UROSTOMY POUCH W/ADAPTERS
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$555.55
|
| 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 |
$520.14
|
| Rate for Payer: Cash Price |
$465.85
|
| Rate for Payer: Cash Price |
$465.85
|
| Rate for Payer: Cigna of CA HMO |
$542.08
|
| Rate for Payer: Cigna of CA PPO |
$626.78
|
| 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 |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| 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 |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.50
|
| Rate for Payer: United Healthcare All Other HMO |
$423.50
|
| Rate for Payer: United Healthcare HMO Rider |
$423.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.50
|
| 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 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Cash Price |
$465.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$338.80
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$524.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Cash Price |
$465.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$338.80
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$524.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$555.55
|
| 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 |
$520.14
|
| Rate for Payer: Blue Shield of California Commercial |
$518.36
|
| Rate for Payer: Blue Shield of California EPN |
$342.19
|
| Rate for Payer: Cash Price |
$465.85
|
| Rate for Payer: Cash Price |
$465.85
|
| Rate for Payer: Cigna of CA HMO |
$542.08
|
| Rate for Payer: Cigna of CA PPO |
$626.78
|
| 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 |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| 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 |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.20
|
| 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 US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.10
|
| Rate for Payer: Blue Shield of California Commercial |
$247.25
|
| Rate for Payer: Blue Shield of California EPN |
$163.22
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Cigna of CA HMO |
$258.56
|
| Rate for Payer: Cigna of CA PPO |
$298.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| 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 |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.50
|
| 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 |
$275.73
|
| Rate for Payer: Blue Shield of California Commercial |
$274.79
|
| Rate for Payer: Blue Shield of California EPN |
$181.40
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO |
$287.36
|
| Rate for Payer: Cigna of CA PPO |
$332.26
|
| 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 |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| 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 |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.48
|
| Rate for Payer: United Healthcare All Other HMO |
$288.48
|
| Rate for Payer: United Healthcare HMO Rider |
$288.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.48
|
| 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 ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
|
|
HC US ABDOMINAL W CONTRAST
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.35
|
| Rate for Payer: Blue Shield of California Commercial |
$492.66
|
| Rate for Payer: Blue Shield of California EPN |
$325.22
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cigna of CA HMO |
$515.20
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC US ABDOMINAL W CONTRAST
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
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 |
$517.00
|
| 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 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 |
$517.00
|
| Rate for Payer: Cash Price |
$517.00
|
| 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 |
$517.00
|
| Rate for Payer: Cash Price |
$517.00
|
| 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 |
$517.00
|
| 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 |
$259.05
|
| 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 |
$259.05
|
| Rate for Payer: Cash Price |
$259.05
|
| 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
|
|
