|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: Adventist Health Commercial |
$148.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$271.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.12
|
| Rate for Payer: Blue Shield of California Commercial |
$278.38
|
| Rate for Payer: Blue Shield of California Commercial |
$183.53
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$307.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$307.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.40
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$307.70
|
| Rate for Payer: Vantage Medical Group Senior |
$307.70
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.61
|
| Rate for Payer: Blue Shield of California Commercial |
$59.21
|
| Rate for Payer: Blue Shield of California Commercial |
$39.04
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
915356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.61
|
| Rate for Payer: Blue Shield of California Commercial |
$59.21
|
| Rate for Payer: Blue Shield of California Commercial |
$39.04
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
915356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
915356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
915356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.60
|
| Rate for Payer: Blue Shield of California Commercial |
$376.81
|
| Rate for Payer: Blue Shield of California Commercial |
$248.43
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.60
|
| Rate for Payer: Blue Shield of California Commercial |
$376.81
|
| Rate for Payer: Blue Shield of California Commercial |
$248.43
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$1,201.05 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$760.42
|
| Rate for Payer: Blue Shield of California Commercial |
$594.87
|
| Rate for Payer: Blue Shield of California Commercial |
$901.49
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cigna of CA HMO |
$904.32
|
| Rate for Payer: Cigna of CA PPO |
$1,045.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$989.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.20
|
| Rate for Payer: EPIC Health Plan Senior |
$565.20
|
| Rate for Payer: Galaxy Health WC |
$1,201.05
|
| Rate for Payer: Global Benefits Group Commercial |
$847.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$512.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.10
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: Networks By Design Commercial |
$918.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$706.50
|
| Rate for Payer: United Healthcare All Other HMO |
$706.50
|
| Rate for Payer: United Healthcare HMO Rider |
$706.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$706.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.05
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$1,201.05 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$989.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.20
|
| Rate for Payer: EPIC Health Plan Senior |
$565.20
|
| Rate for Payer: Galaxy Health WC |
$1,201.05
|
| Rate for Payer: Global Benefits Group Commercial |
$847.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$897.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.12
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: Networks By Design Commercial |
$918.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.05
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$864.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$559.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.35
|
| Rate for Payer: Blue Shield of California Commercial |
$428.16
|
| Rate for Payer: Blue Shield of California Commercial |
$648.85
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$864.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$864.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$369.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$600.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$711.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$711.90
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$508.50
|
| Rate for Payer: United Healthcare All Other HMO |
$508.50
|
| Rate for Payer: United Healthcare HMO Rider |
$508.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$864.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.45
|
| Rate for Payer: Vantage Medical Group Senior |
$864.45
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$600.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$623.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.37
|
| Rate for Payer: Blue Shield of California Commercial |
$461.42
|
| Rate for Payer: Blue Shield of California Commercial |
$699.25
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.97 |
| Max. Negotiated Rate |
$1,172.15 |
| Rate for Payer: Adventist Health Commercial |
$275.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.68
|
| 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 |
$884.90
|
| Rate for Payer: Blue Shield of California Commercial |
$879.80
|
| Rate for Payer: Blue Shield of California Commercial |
$580.56
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$965.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Senior |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$875.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$813.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$965.30
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$1,172.15 |
| Rate for Payer: Adventist Health Commercial |
$275.80
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$965.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$875.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$813.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,555.50 |
| Rate for Payer: Adventist Health Commercial |
$366.00
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,281.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.00
|
| Rate for Payer: EPIC Health Plan Senior |
$732.00
|
| Rate for Payer: Galaxy Health WC |
$1,555.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,162.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,079.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.20
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: Networks By Design Commercial |
$1,189.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,555.50
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
OP
|
$1,830.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$1,555.50 |
| Rate for Payer: Adventist Health Commercial |
$366.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.31
|
| Rate for Payer: Blue Shield of California Commercial |
$770.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,167.54
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Cigna of CA HMO |
$1,171.20
|
| Rate for Payer: Cigna of CA PPO |
$1,354.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,281.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,555.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,162.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: Networks By Design Commercial |
$1,189.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,555.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,098.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$403.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,467.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,712.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,702.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,123.65
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cigna of CA HMO |
$1,708.16
|
| Rate for Payer: Cigna of CA PPO |
$1,975.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,268.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,268.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,868.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,694.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,574.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,868.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,868.30
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,601.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,601.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,268.65
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$403.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,467.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,712.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,702.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,123.65
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Cigna of CA HMO |
$1,708.16
|
| Rate for Payer: Cigna of CA PPO |
$1,975.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,268.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,268.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,868.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,694.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,574.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,868.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,868.30
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,601.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,601.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,334.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,334.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,334.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,334.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,268.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,268.65
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,868.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,694.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,574.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,669.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: Adventist Health Commercial |
$533.80
|
| Rate for Payer: Cash Price |
$1,201.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,868.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,067.60
|
| Rate for Payer: Galaxy Health WC |
$2,268.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,601.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,694.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,574.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.56
|
| Rate for Payer: Multiplan Commercial |
$2,135.20
|
| Rate for Payer: Networks By Design Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,268.65
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
|
