|
HC TUBE TRACH NASAL 2.5MM W/CUFF
|
Facility
OP
|
$31.16
|
|
| Hospital Charge Code |
901698782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.57
|
| Rate for Payer: BCBS Transplant Transplant |
$18.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.96
|
| Rate for Payer: Blue Shield of California EPN |
$18.20
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Media |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE TRACH NASAL 2.5MM W/CUFF
|
Facility
IP
|
$31.16
|
|
| Hospital Charge Code |
901698782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE TRACH NASAL 3.5MM W/CUFF
|
Facility
IP
|
$31.16
|
|
| Hospital Charge Code |
901698783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE TRACH NASAL 3.5MM W/CUFF
|
Facility
OP
|
$31.16
|
|
| Hospital Charge Code |
901698783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.57
|
| Rate for Payer: BCBS Transplant Transplant |
$18.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.96
|
| Rate for Payer: Blue Shield of California EPN |
$18.20
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Media |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
OP
|
$4,169.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.43 |
| Max. Negotiated Rate |
$3,543.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,360.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,483.89
|
| Rate for Payer: BCBS Transplant Transplant |
$2,501.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,463.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.26
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cigna of CA HMO |
$2,668.16
|
| Rate for Payer: Cigna of CA PPO |
$3,085.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$3,543.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,501.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,335.20
|
| Rate for Payer: Networks By Design Commercial |
$2,709.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,543.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,501.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,501.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,501.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
IP
|
$4,169.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,000.56 |
| Max. Negotiated Rate |
$3,543.65 |
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.60
|
| Rate for Payer: Galaxy Health WC |
$3,543.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,501.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.56
|
| Rate for Payer: Multiplan Commercial |
$3,335.20
|
| Rate for Payer: Networks By Design Commercial |
$2,709.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,543.65
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
IP
|
$5,128.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,230.72 |
| Max. Negotiated Rate |
$4,358.80 |
| Rate for Payer: Cash Price |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Galaxy Health WC |
$4,358.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,076.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,420.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,953.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.72
|
| Rate for Payer: Multiplan Commercial |
$4,102.40
|
| Rate for Payer: Networks By Design Commercial |
$3,333.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,358.80
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
OP
|
$5,128.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,230.72 |
| Max. Negotiated Rate |
$4,358.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,897.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,055.26
|
| Rate for Payer: BCBS Transplant Transplant |
$3,076.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,030.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,405.03
|
| Rate for Payer: Cash Price |
$2,307.60
|
| Rate for Payer: Cash Price |
$2,307.60
|
| Rate for Payer: Cigna of CA HMO |
$3,281.92
|
| Rate for Payer: Cigna of CA PPO |
$3,794.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$4,358.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,076.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,846.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,420.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,953.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$4,102.40
|
| Rate for Payer: Networks By Design Commercial |
$3,333.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,358.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,076.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,076.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,076.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC U1RNP AUTO AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: IEHP Medi-Cal |
$29.05
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$29.05
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.08 |
| Max. Negotiated Rate |
$991.95 |
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.80
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.98 |
| Max. Negotiated Rate |
$991.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$550.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.69
|
| Rate for Payer: BCBS Transplant Transplant |
$700.20
|
| Rate for Payer: Blue Shield of California Commercial |
$689.70
|
| Rate for Payer: Blue Shield of California EPN |
$547.32
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cigna of CA HMO |
$746.88
|
| Rate for Payer: Cigna of CA PPO |
$863.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$875.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$700.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$700.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$700.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.41 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$185.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$694.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.50
|
| Rate for Payer: BCBS Transplant Transplant |
$757.80
|
| Rate for Payer: Blue Shield of California Commercial |
$746.43
|
| Rate for Payer: Blue Shield of California EPN |
$592.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$808.32
|
| Rate for Payer: Cigna of CA PPO |
$934.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Media |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$947.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| 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 |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,424.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$520.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$998.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,005.60
|
| Rate for Payer: Blue Shield of California Commercial |
$990.52
|
| Rate for Payer: Blue Shield of California EPN |
$786.04
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna of CA HMO |
$1,072.64
|
| Rate for Payer: Cigna of CA PPO |
$1,240.24
|
| 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 |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,257.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| 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 |
$1,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,005.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.24 |
| Max. Negotiated Rate |
$1,424.60 |
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.40
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$221.44 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$375.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,456.73
|
| Rate for Payer: BCBS Transplant Transplant |
$1,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,146.70
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Dignity Health Media |
$2,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,833.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,222.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,222.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,222.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$221.44 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$375.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,456.73
|
| Rate for Payer: BCBS Transplant Transplant |
$1,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,146.70
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Dignity Health Media |
$2,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,833.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
