|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$580.80 |
| Max. Negotiated Rate |
$2,613.60 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,323.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,161.60
|
| Rate for Payer: Galaxy Health WC |
$2,468.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,742.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,613.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,844.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,713.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: Networks By Design Commercial |
$1,887.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,468.40
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,613.60 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$610.93
|
| 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 Exchange |
$411.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,689.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,829.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.89
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,323.20
|
| Rate for Payer: Cigna of CA HMO |
$1,858.56
|
| Rate for Payer: Cigna of CA PPO |
$2,148.96
|
| 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 |
$2,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,468.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,742.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,613.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,844.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: Networks By Design Commercial |
$1,887.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,468.40
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,742.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,742.40
|
| 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 ULTRASOUND BREAST COMPLETE
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
906676641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: EPIC Health Plan Senior |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC ULTRASOUND BREAST COMPLETE
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
906676641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$516.02 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$434.71
|
| 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 Exchange |
$516.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.61
|
| Rate for Payer: Blue Shield of California Commercial |
$247.59
|
| Rate for Payer: Blue Shield of California EPN |
$156.02
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| 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 |
$275.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$165.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.66
|
| Rate for Payer: United Healthcare All Other HMO |
$234.66
|
| Rate for Payer: United Healthcare HMO Rider |
$234.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.66
|
| 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 ULTRASOUND BREAST LIMITED
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
906676642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Central Health Plan Commercial |
$157.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
|
|
HC ULTRASOUND BREAST LIMITED
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
906676642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$395.05 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$395.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.59
|
| Rate for Payer: Blue Shield of California Commercial |
$124.11
|
| Rate for Payer: Blue Shield of California EPN |
$78.21
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Central Health Plan Commercial |
$157.60
|
| Rate for Payer: Cigna of CA HMO |
$126.08
|
| Rate for Payer: Cigna of CA PPO |
$145.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.66
|
| Rate for Payer: United Healthcare All Other HMO |
$234.66
|
| Rate for Payer: United Healthcare HMO Rider |
$234.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC ULTRASOUND CHEST
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.40 |
| Max. Negotiated Rate |
$1,608.30 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,429.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,250.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.80
|
| Rate for Payer: EPIC Health Plan Senior |
$714.80
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,608.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,134.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,054.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.40
|
| Rate for Payer: Multiplan Commercial |
$1,340.25
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
|
|
HC ULTRASOUND CHEST
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$1,608.30 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.27
|
| 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 Exchange |
$271.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,039.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.81
|
| Rate for Payer: Blue Shield of California EPN |
$709.44
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,429.60
|
| Rate for Payer: Cigna of CA HMO |
$1,143.68
|
| Rate for Payer: Cigna of CA PPO |
$1,322.38
|
| 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 |
$1,250.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,608.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,134.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,340.25
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,072.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,072.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$1,977.30 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$496.32
|
| 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 Exchange |
$296.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,277.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.11
|
| Rate for Payer: Blue Shield of California EPN |
$872.21
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,757.60
|
| Rate for Payer: Cigna of CA HMO |
$1,406.08
|
| Rate for Payer: Cigna of CA PPO |
$1,625.78
|
| 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 |
$1,537.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,977.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,395.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,647.75
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,318.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,318.20
|
| 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 ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
IP
|
$2,197.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$439.40 |
| Max. Negotiated Rate |
$1,977.30 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,757.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,537.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$878.80
|
| Rate for Payer: EPIC Health Plan Senior |
$878.80
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,977.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,395.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,296.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.40
|
| Rate for Payer: Multiplan Commercial |
$1,647.75
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
|
|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$826.01
|
| Rate for Payer: Blue Shield of California Commercial |
$894.60
|
| Rate for Payer: Blue Shield of California EPN |
$563.74
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$994.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Riverside University Health System MISP |
$568.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| 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 |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
OP
|
$2,218.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$1,996.20 |
| Rate for Payer: Adventist Health Commercial |
$443.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$636.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$774.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,290.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.34
|
| Rate for Payer: Blue Shield of California EPN |
$880.55
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,774.40
|
| Rate for Payer: Cigna of CA HMO |
$1,419.52
|
| Rate for Payer: Cigna of CA PPO |
$1,641.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,885.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,330.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,996.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$272.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,408.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,663.50
|
| Rate for Payer: Networks By Design Commercial |
$1,441.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,885.30
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,330.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,330.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
IP
|
$2,218.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$1,996.20 |
| Rate for Payer: Adventist Health Commercial |
$443.60
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,774.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.20
|
| Rate for Payer: EPIC Health Plan Senior |
$887.20
|
| Rate for Payer: Galaxy Health WC |
$1,885.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,330.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,996.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,408.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.60
|
| Rate for Payer: Multiplan Commercial |
$1,663.50
|
| Rate for Payer: Networks By Design Commercial |
$1,441.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,885.30
|
|
