|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| 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 |
$426.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,197.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.17
|
| Rate for Payer: Blue Shield of California EPN |
$817.42
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Cigna of CA HMO |
$1,317.76
|
| Rate for Payer: Cigna of CA PPO |
$1,523.66
|
| 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 |
$1,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,307.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
| 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 |
$1,235.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,235.40
|
| 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 OB GT 14 WK SINGLE FETUS
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$823.60
|
| Rate for Payer: EPIC Health Plan Senior |
$823.60
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,307.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,214.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
|
|
HC ULTRASOUND PELVIC
|
Facility
|
IP
|
$2,623.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$524.60 |
| Max. Negotiated Rate |
$2,360.70 |
| Rate for Payer: Adventist Health Commercial |
$524.60
|
| Rate for Payer: Cash Price |
$1,180.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,098.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,836.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,049.20
|
| Rate for Payer: Galaxy Health WC |
$2,229.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,573.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,360.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,665.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,547.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.60
|
| Rate for Payer: Multiplan Commercial |
$1,967.25
|
| Rate for Payer: Networks By Design Commercial |
$1,704.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,229.55
|
|
|
HC ULTRASOUND PELVIC
|
Facility
|
OP
|
$2,623.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$2,360.70 |
| Rate for Payer: Adventist Health Commercial |
$524.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$578.47
|
| 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 |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,525.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,652.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.33
|
| Rate for Payer: Cash Price |
$1,180.35
|
| Rate for Payer: Cash Price |
$1,180.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,098.40
|
| Rate for Payer: Cigna of CA HMO |
$1,678.72
|
| Rate for Payer: Cigna of CA PPO |
$1,941.02
|
| 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 |
$1,836.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,229.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,573.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,360.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,665.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,967.25
|
| Rate for Payer: Networks By Design Commercial |
$1,704.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,229.55
|
| 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 |
$1,573.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,573.80
|
| 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 RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,701.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.00
|
| Rate for Payer: EPIC Health Plan Senior |
$972.00
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,543.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,433.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
|
|
HC ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| 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 |
$1,413.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,530.90
|
| Rate for Payer: Blue Shield of California EPN |
$964.71
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: Cigna of CA HMO |
$1,555.20
|
| Rate for Payer: Cigna of CA PPO |
$1,798.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,701.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,543.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
| 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 |
$1,458.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,458.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.37 |
| Max. Negotiated Rate |
$1,882.80 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$526.63
|
| 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 |
$296.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.96
|
| Rate for Payer: Blue Shield of California EPN |
$830.52
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,673.60
|
| Rate for Payer: Cigna of CA HMO |
$1,338.88
|
| Rate for Payer: Cigna of CA PPO |
$1,548.08
|
| 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 |
$1,464.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,778.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,882.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,328.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
| Rate for Payer: Networks By Design Commercial |
$1,359.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,778.20
|
| 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 |
$1,255.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,255.20
|
| 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 RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$418.40 |
| Max. Negotiated Rate |
$1,882.80 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,673.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,464.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.80
|
| Rate for Payer: EPIC Health Plan Senior |
$836.80
|
| Rate for Payer: Galaxy Health WC |
$1,778.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,882.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,328.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,234.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.40
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
| Rate for Payer: Networks By Design Commercial |
$1,359.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,778.20
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
IP
|
$2,763.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$552.60 |
| Max. Negotiated Rate |
$2,486.70 |
| Rate for Payer: Adventist Health Commercial |
$552.60
|
| Rate for Payer: Cash Price |
$1,243.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,210.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,934.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,105.20
|
| Rate for Payer: Galaxy Health WC |
$2,348.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,657.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,486.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,754.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,630.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.60
|
| Rate for Payer: Multiplan Commercial |
$2,072.25
|
| Rate for Payer: Networks By Design Commercial |
$1,795.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,348.55
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
OP
|
$2,763.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,486.70 |
| Rate for Payer: Adventist Health Commercial |
$552.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.63
|
| 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 |
$389.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,607.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,740.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,096.91
|
| Rate for Payer: Cash Price |
$1,243.35
|
| Rate for Payer: Cash Price |
$1,243.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,210.40
|
| Rate for Payer: Cigna of CA HMO |
$1,768.32
|
| Rate for Payer: Cigna of CA PPO |
$2,044.62
|
| 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 |
$1,934.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,348.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,657.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,486.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,754.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,072.25
|
| Rate for Payer: Networks By Design Commercial |
$1,795.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,348.55
|
| 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 |
$1,657.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,657.80
|
| 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 TRANSVAGINAL
|
Facility
|
OP
|
$2,366.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$580.62
|
| 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 |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,376.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,490.58
|
| Rate for Payer: Blue Shield of California EPN |
$939.30
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Cigna of CA HMO |
$1,514.24
|
| Rate for Payer: Cigna of CA PPO |
$1,750.84
|
| 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 |
$1,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,502.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
| 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 |
$1,419.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,419.60
|
| 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: 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 TRANSVAGINAL
|
Facility
|
IP
|
$2,366.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$473.20 |
| Max. Negotiated Rate |
$2,129.40 |
| Rate for Payer: Adventist Health Commercial |
$473.20
|
| Rate for Payer: Cash Price |
$1,064.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$946.40
|
| Rate for Payer: Galaxy Health WC |
$2,011.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,502.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,395.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.20
|
| Rate for Payer: Multiplan Commercial |
$1,774.50
|
| Rate for Payer: Networks By Design Commercial |
$1,537.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,011.10
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$323.00 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,130.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.00
|
| Rate for Payer: EPIC Health Plan Senior |
$646.00
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,025.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$952.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.71
|
| 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 |
$325.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$939.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.45
|
| Rate for Payer: Blue Shield of California EPN |
$641.15
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,292.00
|
| Rate for Payer: Cigna of CA HMO |
$1,033.60
|
| Rate for Payer: Cigna of CA PPO |
$1,195.10
|
| 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 |
$1,130.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,372.75
|
| Rate for Payer: Global Benefits Group Commercial |
$969.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,453.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,025.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Networks By Design Commercial |
$1,049.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,372.75
|
| 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 |
$969.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$969.00
|
| 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: 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 UMBILICAL VEIN CATH NEWBORN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Riverside University Health System MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC UNLISTED MODALITY OT
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905104039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| 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 |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Riverside University Health System MISP |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY OT
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905104039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.60
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC UNLISTED MODALITY PT
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.60
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC UNLISTED MODALITY PT
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| 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 |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Riverside University Health System MISP |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$272.70 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.60
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| 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 |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Central Health Plan Commercial |
$242.40
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Senior |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Riverside University Health System MISP |
$121.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,605.10 |
| Rate for Payer: Adventist Health Commercial |
$1,467.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,871.20
|
| Rate for Payer: Cigna of CA HMO |
$4,696.96
|
| Rate for Payer: Cigna of CA PPO |
$5,430.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,137.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$6,238.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,403.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,605.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,660.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$5,504.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$4,770.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$6,238.15
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,403.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,669.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,669.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,669.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,669.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,467.80 |
| Max. Negotiated Rate |
$6,605.10 |
| Rate for Payer: Adventist Health Commercial |
$1,467.80
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,871.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,137.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,935.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,935.60
|
| Rate for Payer: Galaxy Health WC |
$6,238.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,403.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,605.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,660.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,330.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.80
|
| Rate for Payer: Multiplan Commercial |
$5,504.25
|
| Rate for Payer: Networks By Design Commercial |
$4,770.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,238.15
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
IP
|
$6,623.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,324.60 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,636.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,649.20
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,907.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
|
