|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Adventist Health Commercial |
$256.40
|
| Rate for Payer: Cash Price |
$705.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Senior |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$793.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$561.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$447.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$542.67
|
| Rate for Payer: Blue Shield of California Commercial |
$560.87
|
| Rate for Payer: Blue Shield of California EPN |
$366.83
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Cigna of CA HMO |
$591.36
|
| Rate for Payer: Cigna of CA PPO |
$683.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$785.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$785.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: InnovAge PACE Commercial |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$646.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$646.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
| Rate for Payer: Riverside University Health System MISP |
$369.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$554.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.00
|
| Rate for Payer: United Healthcare All Other HMO |
$462.00
|
| Rate for Payer: United Healthcare HMO Rider |
$462.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Vantage Medical Group Senior |
$785.40
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.86 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.86
|
| Rate for Payer: Blue Shield of California Commercial |
$604.57
|
| Rate for Payer: Blue Shield of California EPN |
$395.41
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$833.97
|
| Rate for Payer: Blue Shield of California Commercial |
$861.94
|
| Rate for Payer: Blue Shield of California EPN |
$563.74
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.23
|
| Rate for Payer: InnovAge PACE Commercial |
$710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$878.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: Riverside University Health System MISP |
$568.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.88 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,143.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,105.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,142.98
|
| Rate for Payer: Blue Shield of California EPN |
$747.55
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,506.40
|
| Rate for Payer: Cigna of CA HMO |
$1,205.12
|
| Rate for Payer: Cigna of CA PPO |
$1,393.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,600.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,129.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,694.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,255.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: Networks By Design Commercial |
$1,223.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,600.55
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,129.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,129.80
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.60 |
| Max. Negotiated Rate |
$1,694.70 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,506.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$753.20
|
| Rate for Payer: EPIC Health Plan Senior |
$753.20
|
| Rate for Payer: Galaxy Health WC |
$1,600.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,129.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,694.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,255.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,165.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.60
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: Networks By Design Commercial |
$1,223.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,600.55
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.47 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,668.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,511.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,061.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$472.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,613.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,668.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,090.96
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Cigna of CA HMO |
$1,758.72
|
| Rate for Payer: Cigna of CA PPO |
$2,033.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,335.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.47
|
| Rate for Payer: InnovAge PACE Commercial |
$1,374.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,701.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,923.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,923.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,099.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,648.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,374.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,374.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$200.47 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,668.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,511.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,061.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$472.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,613.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,668.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,090.96
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Cigna of CA HMO |
$1,758.72
|
| Rate for Payer: Cigna of CA PPO |
$2,033.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,335.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.47
|
| Rate for Payer: InnovAge PACE Commercial |
$1,374.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,701.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,923.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,923.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,099.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,648.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,701.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,832.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,701.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.78
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
