|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$659.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.34
|
| Rate for Payer: Blue Distinction Transplant |
$465.60
|
| Rate for Payer: Blue Shield of California Commercial |
$571.91
|
| Rate for Payer: Blue Shield of California EPN |
$453.18
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO |
$496.64
|
| Rate for Payer: Cigna of CA PPO |
$574.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$582.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.00
|
| Rate for Payer: United Healthcare All Other HMO |
$388.00
|
| Rate for Payer: United Healthcare HMO Rider |
$388.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$388.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$206.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$203.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.45
|
| Rate for Payer: Blue Distinction Transplant |
$222.00
|
| Rate for Payer: Blue Shield of California Commercial |
$218.67
|
| Rate for Payer: Blue Shield of California EPN |
$173.53
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO |
$236.80
|
| Rate for Payer: Cigna of CA PPO |
$273.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Media |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$277.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| 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 |
$314.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$426.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$426.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.87
|
| Rate for Payer: Blue Distinction Transplant |
$246.60
|
| Rate for Payer: Blue Shield of California Commercial |
$242.90
|
| Rate for Payer: Blue Shield of California EPN |
$192.76
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$427.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.98
|
| Rate for Payer: Blue Distinction Transplant |
$516.60
|
| Rate for Payer: Blue Shield of California Commercial |
$508.85
|
| Rate for Payer: Blue Shield of California EPN |
$403.81
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$645.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$500.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.98
|
| Rate for Payer: Blue Distinction Transplant |
$516.60
|
| Rate for Payer: Blue Shield of California Commercial |
$508.85
|
| Rate for Payer: Blue Shield of California EPN |
$403.81
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$645.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$366.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$217.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$366.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.79
|
| Rate for Payer: Blue Distinction Transplant |
$258.60
|
| Rate for Payer: Blue Shield of California Commercial |
$254.72
|
| Rate for Payer: Blue Shield of California EPN |
$202.14
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.35
|
| Rate for Payer: Dignity Health Media |
$366.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$366.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$323.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.44
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.50
|
| Rate for Payer: United Healthcare All Other HMO |
$215.50
|
| Rate for Payer: United Healthcare HMO Rider |
$215.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$366.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.35
|
| Rate for Payer: Vantage Medical Group Senior |
$366.35
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$103.44 |
| Max. Negotiated Rate |
$366.35 |
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.44
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$343.92 |
| Max. Negotiated Rate |
$1,218.05 |
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.20
|
| Rate for Payer: Galaxy Health WC |
$1,218.05
|
| Rate for Payer: Global Benefits Group Commercial |
$859.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$955.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.92
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Networks By Design Commercial |
$931.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.05
|
|
|
HC US GUID AMNIOCENTESIS
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
902400752
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,218.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$788.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$788.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$853.78
|
| Rate for Payer: Blue Distinction Transplant |
$859.80
|
| Rate for Payer: Blue Shield of California Commercial |
$846.90
|
| Rate for Payer: Blue Shield of California EPN |
$672.08
|
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: Cash Price |
$644.85
|
| Rate for Payer: Cigna of CA HMO |
$917.12
|
| Rate for Payer: Cigna of CA PPO |
$1,060.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Dignity Health Media |
$1,218.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,218.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$573.20
|
| Rate for Payer: Galaxy Health WC |
$1,218.05
|
| Rate for Payer: Global Benefits Group Commercial |
$859.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,074.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$955.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.92
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Networks By Design Commercial |
$931.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$859.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$859.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$716.50
|
| Rate for Payer: United Healthcare All Other HMO |
$716.50
|
| Rate for Payer: United Healthcare HMO Rider |
$716.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$716.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,218.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,218.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,218.05
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.62 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.35
|
| Rate for Payer: Blue Distinction Transplant |
$606.60
|
| Rate for Payer: Blue Shield of California Commercial |
$597.50
|
| Rate for Payer: Blue Shield of California EPN |
$474.16
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$859.35
|
| Rate for Payer: Dignity Health Media |
$859.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$859.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$758.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.64
|
| Rate for Payer: Multiplan Commercial |
$808.80
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$859.35
|
| Rate for Payer: Vantage Medical Group Senior |
$859.35
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.64 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.64
|
| Rate for Payer: Multiplan Commercial |
$808.80
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.28 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,277.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.45
|
| Rate for Payer: Blue Distinction Transplant |
$1,393.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.02
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Dignity Health Media |
$1,973.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.28 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,277.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.45
|
| Rate for Payer: Blue Distinction Transplant |
$1,393.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.02
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Dignity Health Media |
$1,973.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.28 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
901200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,046.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,277.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,277.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.45
|
| Rate for Payer: Blue Distinction Transplant |
$1,393.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.02
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Dignity Health Media |
$1,973.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,741.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.28
|
| Rate for Payer: Multiplan Commercial |
$1,857.60
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,973.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.70
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
901200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$514.32 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,178.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,178.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,276.80
|
| Rate for Payer: Blue Distinction Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,266.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.07
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Dignity Health Media |
$1,821.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,607.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
901200114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,178.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,178.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,276.80
|
| Rate for Payer: Blue Distinction Transplant |
$1,285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,266.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.07
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cigna of CA HMO |
$1,371.52
|
| Rate for Payer: Cigna of CA PPO |
$1,585.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Dignity Health Media |
$1,821.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,607.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,285.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$514.32 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.20
|
| Rate for Payer: Galaxy Health WC |
$1,821.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.32
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: Networks By Design Commercial |
$1,392.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.55
|
|
