|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$350.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$694.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.18
|
| Rate for Payer: BCBS Transplant Transplant |
$757.80
|
| Rate for Payer: Blue Shield of California Commercial |
$780.53
|
| Rate for Payer: Blue Shield of California EPN |
$613.82
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$808.32
|
| Rate for Payer: Cigna of CA PPO |
$934.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$947.25
|
| Rate for Payer: IEHP medi-cal |
$442.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: Riverside University Health MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
OP
|
$1,973.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$38,945.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$562.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$774.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,165.65
|
| Rate for Payer: BCBS Transplant Transplant |
$1,183.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,219.31
|
| Rate for Payer: Blue Shield of California EPN |
$958.88
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,578.40
|
| Rate for Payer: Cigna of CA HMO |
$1,262.72
|
| Rate for Payer: Cigna of CA PPO |
$1,460.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,677.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,183.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,775.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,479.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: Networks By Design Commercial |
$1,282.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,677.05
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,183.80
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,183.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,183.80
|
| 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 |
$38,945.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
IP
|
$1,973.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$1,775.70 |
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,578.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$789.20
|
| Rate for Payer: Galaxy Health WC |
$1,677.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,183.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,775.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.60
|
| Rate for Payer: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: Networks By Design Commercial |
$1,282.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,677.05
|
|
|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,465.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.80
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,648.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.40
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
|
|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$539.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,082.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1,099.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.18
|
| Rate for Payer: Blue Shield of California EPN |
$890.35
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,465.60
|
| Rate for Payer: Cigna of CA HMO |
$1,172.48
|
| Rate for Payer: Cigna of CA PPO |
$1,355.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,557.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,648.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,374.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,221.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,557.20
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,099.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,099.20
|
| 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 |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND PELVIC
|
Facility
OP
|
$2,334.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,378.93
|
| Rate for Payer: BCBS Transplant Transplant |
$1,400.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,442.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,134.32
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,867.20
|
| Rate for Payer: Cigna of CA HMO |
$1,493.76
|
| Rate for Payer: Cigna of CA PPO |
$1,727.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,983.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,400.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,100.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,750.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,750.50
|
| Rate for Payer: Networks By Design Commercial |
$1,517.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,983.90
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,400.40
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,400.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,400.40
|
| 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 |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND PELVIC
|
Facility
IP
|
$2,334.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$2,100.60 |
| Rate for Payer: Cash Price |
$1,050.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,867.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$933.60
|
| Rate for Payer: Galaxy Health WC |
$1,983.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,400.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,100.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,556.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.80
|
| Rate for Payer: Multiplan Commercial |
$1,750.50
|
| Rate for Payer: Networks By Design Commercial |
$1,517.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,983.90
|
|
|
HC ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$539.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,277.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1,297.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,336.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,050.73
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,383.68
|
| Rate for Payer: Cigna of CA PPO |
$1,599.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,621.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| 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 |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
IP
|
$1,862.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$1,675.80 |
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.80
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,675.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,241.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Networks By Design Commercial |
$1,210.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,582.70
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$465.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$296.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,100.07
|
| Rate for Payer: BCBS Transplant Transplant |
$1,117.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.72
|
| Rate for Payer: Blue Shield of California EPN |
$904.93
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| Rate for Payer: Cigna of CA HMO |
$1,191.68
|
| Rate for Payer: Cigna of CA PPO |
$1,377.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,675.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,396.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,241.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Networks By Design Commercial |
$1,210.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,582.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,117.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.20
|
| 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 |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,212.20 |
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,966.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,212.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$642.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$389.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,452.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1,474.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,519.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,194.59
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,966.40
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,212.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,843.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,474.80
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.80
|
| 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 |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND TRANSVAGINAL
|
Facility
IP
|
$2,105.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$421.00 |
| Max. Negotiated Rate |
$1,894.50 |
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,684.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.00
|
| Rate for Payer: Galaxy Health WC |
$1,789.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,894.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.00
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: Networks By Design Commercial |
$1,368.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,789.25
|
|
|
HC ULTRASOUND TRANSVAGINAL
|
Facility
OP
|
$2,105.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,243.63
|
| Rate for Payer: BCBS Transplant Transplant |
$1,263.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,023.03
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,684.00
|
| Rate for Payer: Cigna of CA HMO |
$1,347.20
|
| Rate for Payer: Cigna of CA PPO |
$1,557.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,789.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,894.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,578.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: Networks By Design Commercial |
$1,368.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,789.25
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,263.00
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,263.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,263.00
|
| 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 |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$1,293.30 |
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,149.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.80
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,293.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.40
|
| Rate for Payer: Multiplan Commercial |
$1,077.75
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$325.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$848.98
|
| Rate for Payer: BCBS Transplant Transplant |
$862.20
|
| Rate for Payer: Blue Shield of California Commercial |
$888.07
|
| Rate for Payer: Blue Shield of California EPN |
$698.38
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,149.60
|
| Rate for Payer: Cigna of CA HMO |
$919.68
|
| Rate for Payer: Cigna of CA PPO |
$1,063.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,293.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,077.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,077.75
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.20
|
| 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 |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$318.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$189.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$189.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$206.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Central Health Plan Commercial |
$275.20
|
| Rate for Payer: Cigna of CA PPO |
$254.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.60
|
| Rate for Payer: Galaxy Health WC |
$292.40
|
| Rate for Payer: Global Benefits Group Commercial |
$206.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$258.00
|
| Rate for Payer: IEHP medi-cal |
$120.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$258.00
|
| Rate for Payer: Networks By Design Commercial |
$223.60
|
| Rate for Payer: Prime Health Services Commercial |
$292.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$206.40
|
| Rate for Payer: Riverside University Health MISP |
$137.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$292.40
|
| Rate for Payer: Vantage Medical Group Senior |
$292.40
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Central Health Plan Commercial |
$275.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.60
|
| Rate for Payer: Galaxy Health WC |
$292.40
|
| Rate for Payer: Global Benefits Group Commercial |
$206.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$258.00
|
| Rate for Payer: Networks By Design Commercial |
$223.60
|
| Rate for Payer: Prime Health Services Commercial |
$292.40
|
|
|
HC UNLISTED MODALITY OT
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905104039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC UNLISTED MODALITY OT
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905104039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$227.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$206.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$281.25
|
| Rate for Payer: IEHP medi-cal |
$131.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$150.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC UNLISTED MODALITY PT
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC UNLISTED MODALITY PT
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$227.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$206.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$281.25
|
| Rate for Payer: IEHP medi-cal |
$131.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$150.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$227.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$206.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$281.25
|
| Rate for Payer: IEHP medi-cal |
$131.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$150.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
