|
HC ULTRASOUND 30 MIN PT WC
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 97128
|
| Hospital Charge Code |
900417128
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$73.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.25
|
| 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 |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: InnovAge PACE Commercial |
$89.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.30
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Riverside University Health System MISP |
$71.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| 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 |
$152.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.15
|
| Rate for Payer: Vantage Medical Group Senior |
$152.15
|
|
|
HC ULTRASOUND 30 MIN PT WC
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 97128
|
| Hospital Charge Code |
900417128
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$580.80 |
| Max. Negotiated Rate |
$2,613.60 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Cash Price |
$1,597.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,161.60
|
| Rate for Payer: Galaxy Health WC |
$2,468.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,742.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,613.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,106.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,797.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: Networks By Design Commercial |
$1,887.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,468.40
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,613.60 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,763.60
|
| 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 |
$411.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,705.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,762.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.89
|
| Rate for Payer: Cash Price |
$1,597.20
|
| Rate for Payer: Cash Price |
$1,597.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,323.20
|
| Rate for Payer: Cigna of CA HMO |
$1,858.56
|
| Rate for Payer: Cigna of CA PPO |
$2,148.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,468.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,742.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,613.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.10
|
| 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 |
$1,936.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.80
|
| 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 |
$2,178.00
|
| Rate for Payer: Networks By Design Commercial |
$1,887.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,468.40
|
| 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 |
$1,742.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,742.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND BREAST COMPLETE
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
906676641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$516.02 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.67
|
| 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 |
$516.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.81
|
| Rate for Payer: Blue Shield of California Commercial |
$238.55
|
| Rate for Payer: Blue Shield of California EPN |
$156.02
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$165.52
|
| 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 |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| 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 |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| 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 |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.66
|
| Rate for Payer: United Healthcare All Other HMO |
$234.66
|
| Rate for Payer: United Healthcare HMO Rider |
$234.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND BREAST COMPLETE
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
906676641
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: EPIC Health Plan Senior |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC ULTRASOUND BREAST LIMITED
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
906676642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$395.05 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$395.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.70
|
| Rate for Payer: Blue Shield of California Commercial |
$119.58
|
| Rate for Payer: Blue Shield of California EPN |
$78.21
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Central Health Plan Commercial |
$157.60
|
| Rate for Payer: Cigna of CA HMO |
$126.08
|
| Rate for Payer: Cigna of CA PPO |
$145.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.66
|
| Rate for Payer: United Healthcare All Other HMO |
$234.66
|
| Rate for Payer: United Healthcare HMO Rider |
$234.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ULTRASOUND BREAST LIMITED
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
906676642
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Central Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
|
|
HC ULTRASOUND CHEST
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$1,608.30 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,085.25
|
| 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 |
$271.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,049.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,084.71
|
| Rate for Payer: Blue Shield of California EPN |
$709.44
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,429.60
|
| Rate for Payer: Cigna of CA HMO |
$1,143.68
|
| Rate for Payer: Cigna of CA PPO |
$1,322.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,608.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.45
|
| 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 |
$1,191.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.40
|
| 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 |
$1,340.25
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
| 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 |
$1,072.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,072.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND CHEST
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$357.40 |
| Max. Negotiated Rate |
$1,608.30 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,429.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.80
|
| Rate for Payer: EPIC Health Plan Senior |
$714.80
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,608.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.40
|
| Rate for Payer: Multiplan Commercial |
$1,340.25
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
IP
|
$2,197.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$439.40 |
| Max. Negotiated Rate |
$1,977.30 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,757.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$878.80
|
| Rate for Payer: EPIC Health Plan Senior |
$878.80
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,977.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,465.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,359.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.40
|
| Rate for Payer: Multiplan Commercial |
$1,647.75
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$1,977.30 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,334.24
|
| 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 |
$296.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,290.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.58
|
| Rate for Payer: Blue Shield of California EPN |
$872.21
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,757.60
|
| Rate for Payer: Cigna of CA HMO |
$1,406.08
|
| Rate for Payer: Cigna of CA PPO |
$1,625.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,977.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.47
|
| 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 |
$1,465.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.40
|
| 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 |
$1,647.75
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
| 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 |
$1,318.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,318.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$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 ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$1,278.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$269.23
|
| 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 |
$309.62
|
| 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 |
$342.02
|
| 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: 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 ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
IP
|
$2,218.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$1,996.20 |
| Rate for Payer: Adventist Health Commercial |
$443.60
|
| Rate for Payer: Cash Price |
$1,219.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,774.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.20
|
| Rate for Payer: EPIC Health Plan Senior |
$887.20
|
| Rate for Payer: Galaxy Health WC |
$1,885.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,330.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,996.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,479.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,372.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.60
|
| Rate for Payer: Multiplan Commercial |
$1,663.50
|
| Rate for Payer: Networks By Design Commercial |
$1,441.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,885.30
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
OP
|
$2,218.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$1,996.20 |
| Rate for Payer: Adventist Health Commercial |
$443.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,346.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$774.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,302.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,346.33
|
| Rate for Payer: Blue Shield of California EPN |
$880.55
|
| Rate for Payer: Cash Price |
$1,219.90
|
| Rate for Payer: Cash Price |
$1,219.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,774.40
|
| Rate for Payer: Cigna of CA HMO |
$1,419.52
|
| Rate for Payer: Cigna of CA PPO |
$1,641.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,885.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,330.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,996.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$272.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,479.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,663.50
|
| Rate for Payer: Networks By Design Commercial |
$1,441.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,885.30
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,330.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,330.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$823.60
|
| Rate for Payer: EPIC Health Plan Senior |
$823.60
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,373.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$784.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,274.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
|
|
HC ULTRASOUND OB GT 14 WK SINGLE FETUS
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
906601300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,250.43
|
| 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 |
$426.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,209.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,249.81
|
| Rate for Payer: Blue Shield of California EPN |
$817.42
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Cash Price |
$1,132.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Cigna of CA HMO |
$1,317.76
|
| Rate for Payer: Cigna of CA PPO |
$1,523.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.23
|
| 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 |
$1,373.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| 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 |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
| 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 |
$1,235.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,235.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND PELVIC
|
Facility
|
IP
|
$2,623.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$524.60 |
| Max. Negotiated Rate |
$2,360.70 |
| Rate for Payer: Adventist Health Commercial |
$524.60
|
| Rate for Payer: Cash Price |
$1,442.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,098.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,049.20
|
| Rate for Payer: Galaxy Health WC |
$2,229.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,573.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,360.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,749.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$999.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,623.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.60
|
| Rate for Payer: Multiplan Commercial |
$1,967.25
|
| Rate for Payer: Networks By Design Commercial |
$1,704.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,229.55
|
|
|
HC ULTRASOUND PELVIC
|
Facility
|
OP
|
$2,623.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.36 |
| Max. Negotiated Rate |
$2,360.70 |
| Rate for Payer: Adventist Health Commercial |
$524.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,592.95
|
| 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 |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,540.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,592.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.33
|
| Rate for Payer: Cash Price |
$1,442.65
|
| Rate for Payer: Cash Price |
$1,442.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,098.40
|
| Rate for Payer: Cigna of CA HMO |
$1,678.72
|
| Rate for Payer: Cigna of CA PPO |
$1,941.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,229.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,573.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,360.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.36
|
| 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 |
$1,749.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.60
|
| 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 |
$1,967.25
|
| Rate for Payer: Networks By Design Commercial |
$1,704.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,229.55
|
| 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 |
$1,573.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,573.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,475.74
|
| 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 |
$411.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,427.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,475.01
|
| Rate for Payer: Blue Shield of California EPN |
$964.71
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: Cigna of CA HMO |
$1,555.20
|
| Rate for Payer: Cigna of CA PPO |
$1,798.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.84
|
| 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 |
$1,620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| 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 |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
| 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 |
$1,458.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,458.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.00
|
| Rate for Payer: EPIC Health Plan Senior |
$972.00
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$925.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,504.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$418.40 |
| Max. Negotiated Rate |
$1,882.80 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,673.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.80
|
| Rate for Payer: EPIC Health Plan Senior |
$836.80
|
| Rate for Payer: Galaxy Health WC |
$1,778.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,882.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.40
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
| Rate for Payer: Networks By Design Commercial |
$1,359.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,778.20
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.37 |
| Max. Negotiated Rate |
$1,882.80 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,270.47
|
| 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 |
$296.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.84
|
| Rate for Payer: Blue Shield of California EPN |
$830.52
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,673.60
|
| Rate for Payer: Cigna of CA HMO |
$1,338.88
|
| Rate for Payer: Cigna of CA PPO |
$1,548.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,778.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,882.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.37
|
| 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 |
$1,395.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.40
|
| 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 |
$1,569.00
|
| Rate for Payer: Networks By Design Commercial |
$1,359.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,778.20
|
| 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 |
$1,255.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,255.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
IP
|
$2,763.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$552.60 |
| Max. Negotiated Rate |
$2,486.70 |
| Rate for Payer: Adventist Health Commercial |
$552.60
|
| Rate for Payer: Cash Price |
$1,519.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,105.20
|
| Rate for Payer: Galaxy Health WC |
$2,348.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,657.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,486.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,842.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,052.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,710.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.60
|
| Rate for Payer: Multiplan Commercial |
$2,072.25
|
| Rate for Payer: Networks By Design Commercial |
$1,795.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,348.55
|
|
