|
HC UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$2,038.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,400.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.32
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.52
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.14 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.09
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.85
|
| Rate for Payer: Heritage Provider Network Senior |
$557.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Multiplan Commercial |
$618.00
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$533.25 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$358.91
|
| Rate for Payer: Blue Shield of California EPN |
$204.10
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$462.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.11
|
| Rate for Payer: Heritage Provider Network Senior |
$440.11
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$511.70
|
| Rate for Payer: Blue Shield of California EPN |
$483.69
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.06
|
| Rate for Payer: Heritage Provider Network Senior |
$510.06
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$618.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$412.00
|
| Rate for Payer: TriValley Medical Group Senior |
$412.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$533.25 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.46
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$481.35
|
| Rate for Payer: Heritage Provider Network Senior |
$481.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.75
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Blue Shield of California Commercial |
$184.35
|
| Rate for Payer: Blue Shield of California EPN |
$104.83
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Senior |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$366.14 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$366.14
|
| Rate for Payer: Blue Shield of California EPN |
$208.21
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$366.14
|
| Rate for Payer: Blue Shield of California EPN |
$208.21
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$428.91
|
| Rate for Payer: Blue Shield of California EPN |
$243.91
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$343.50 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.65
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.07
|
| Rate for Payer: Heritage Provider Network Senior |
$310.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.50
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Blue Shield of California Commercial |
$186.31
|
| Rate for Payer: Blue Shield of California EPN |
$105.95
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$297.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Senior |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$283.50
|
| Rate for Payer: Heritage Provider Network Senior |
$283.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.50
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.65 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$758.25
|
| Rate for Payer: Blue Shield of California Commercial |
$311.24
|
| Rate for Payer: Blue Shield of California EPN |
$176.99
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$657.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$859.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$859.35
|
| Rate for Payer: Dignity Health Senior |
$859.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.81
|
| Rate for Payer: Heritage Provider Network Senior |
$625.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$487.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$859.35
|
| Rate for Payer: Vantage Medical Group Senior |
$859.35
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$758.25 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.56
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.45
|
| Rate for Payer: Heritage Provider Network Senior |
$684.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$1,439.90 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,439.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$931.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,270.50
|
| Rate for Payer: Blue Shield of California Commercial |
$512.13
|
| Rate for Payer: Blue Shield of California EPN |
$291.24
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,439.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,439.90
|
| Rate for Payer: Dignity Health Senior |
$1,439.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,048.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$816.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,439.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,439.90
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$1,439.90 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,439.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$931.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,270.50
|
| Rate for Payer: Blue Shield of California Commercial |
$512.13
|
| Rate for Payer: Blue Shield of California EPN |
$291.24
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,439.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,439.90
|
| Rate for Payer: Dignity Health Senior |
$1,439.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,048.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$816.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,439.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,439.90
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$523.50 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.55
|
| Rate for Payer: Heritage Provider Network Senior |
$472.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Blue Shield of California Commercial |
$86.58
|
| Rate for Payer: Blue Shield of California EPN |
$49.24
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Senior |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.06
|
| Rate for Payer: Heritage Provider Network Senior |
$432.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Adventist Health Commercial |
$428.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,472.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,178.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,607.25
|
| Rate for Payer: Blue Shield of California Commercial |
$86.58
|
| Rate for Payer: Blue Shield of California EPN |
$49.24
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,392.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.55
|
| Rate for Payer: Dignity Health Senior |
$1,821.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,326.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,326.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,032.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.75
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$387.88 |
| Max. Negotiated Rate |
$1,607.25 |
| Rate for Payer: Adventist Health Commercial |
$428.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,472.24
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,450.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,450.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.75
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
|
