|
HC U1RNP AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.82 |
| Max. Negotiated Rate |
$1,511.30 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$950.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,221.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,511.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,333.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,084.58
|
| Rate for Payer: Blue Shield of California EPN |
$867.66
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,155.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,511.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,511.30
|
| Rate for Payer: Dignity Health Senior |
$1,511.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,100.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,100.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$848.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,244.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,244.60
|
| Rate for Payer: Multiplan Commercial |
$1,333.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$889.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$889.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,511.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,511.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,511.30
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.82 |
| Max. Negotiated Rate |
$1,333.50 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,203.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,203.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.50
|
| Rate for Payer: Multiplan Commercial |
$1,333.50
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$799.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,027.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$822.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,121.25
|
| Rate for Payer: Blue Shield of California Commercial |
$911.95
|
| Rate for Payer: Blue Shield of California EPN |
$729.56
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$971.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: Dignity Health Senior |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$971.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$925.40
|
| Rate for Payer: Heritage Provider Network Senior |
$925.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$713.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$747.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$747.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,121.25 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Cash Price |
$822.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,012.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,012.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.75
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$599.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$770.13
|
| 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 HMO/PPO |
$431.96
|
| Rate for Payer: Blue Shield of California Commercial |
$347.76
|
| Rate for Payer: Blue Shield of California EPN |
$279.66
|
| Rate for Payer: Cash Price |
$616.55
|
| Rate for Payer: Cash Price |
$616.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$728.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.90
|
| Rate for Payer: Heritage Provider Network Senior |
$693.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$534.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$840.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| 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
|
$1,121.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.90 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Cash Price |
$616.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.92
|
| Rate for Payer: Heritage Provider Network Senior |
$758.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.25
|
| Rate for Payer: Multiplan Commercial |
$840.75
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$556.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$715.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$573.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$781.50
|
| Rate for Payer: Blue Shield of California Commercial |
$231.46
|
| Rate for Payer: Blue Shield of California EPN |
$186.13
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$885.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$885.70
|
| Rate for Payer: Dignity Health Senior |
$885.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.00
|
| Rate for Payer: Heritage Provider Network Senior |
$645.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$497.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$729.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$729.40
|
| Rate for Payer: Multiplan Commercial |
$781.50
|
| 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 Commercial/Exchange |
$885.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$885.70
|
| Rate for Payer: Vantage Medical Group Senior |
$885.70
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$781.50 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$705.43
|
| Rate for Payer: Heritage Provider Network Senior |
$705.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.50
|
| Rate for Payer: Multiplan Commercial |
$781.50
|
|
|
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 |
$127.04 |
| Max. Negotiated Rate |
$1,412.25 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,006.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,293.62
|
| 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: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,223.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,165.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,165.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$898.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| 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 |
$340.82 |
| Max. Negotiated Rate |
$1,412.25 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,274.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,274.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,099.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$1,574.25 |
| Rate for Payer: Adventist Health Commercial |
$419.80
|
| Rate for Payer: Cash Price |
$1,154.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,421.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.75
|
| Rate for Payer: Multiplan Commercial |
$1,574.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$497.39 |
| Max. Negotiated Rate |
$2,061.00 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,511.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,860.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,860.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.00
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$188.81 |
| Max. Negotiated Rate |
$2,335.80 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,468.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,887.88
|
| 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: Blue Shield of California Commercial |
$1,676.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,341.02
|
| 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: Cigna of CA HMO/PPO |
$1,786.20
|
| 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 Senior |
$2,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,786.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,701.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,701.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,310.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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
|
$2,099.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.81 |
| Max. Negotiated Rate |
$1,784.15 |
| Rate for Payer: Adventist Health Commercial |
$419.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,121.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,442.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,574.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,280.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,024.31
|
| Rate for Payer: Cash Price |
$1,154.45
|
| Rate for Payer: Cash Price |
$1,154.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,364.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,784.15
|
| Rate for Payer: Dignity Health Senior |
$1,784.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,364.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,299.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,299.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,001.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,469.30
|
| Rate for Payer: Multiplan Commercial |
$1,574.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,049.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,049.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,784.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,784.15
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Senior |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Senior |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Senior |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Senior |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Senior |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
