|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$442.54 |
| Max. Negotiated Rate |
$1,833.75 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,679.72
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,655.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,655.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.25
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
OP
|
$1,797.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$1,527.45 |
| Rate for Payer: Adventist Health Commercial |
$359.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,234.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,527.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$988.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,347.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,115.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,054.84
|
| Rate for Payer: Cash Price |
$808.65
|
| Rate for Payer: Cash Price |
$808.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,168.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,527.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,527.45
|
| Rate for Payer: Dignity Health Senior |
$1,527.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,168.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,112.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,112.34
|
| Rate for Payer: IEHP Medi-Cal |
$181.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$866.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.25
|
| Rate for Payer: Multiplan Commercial |
$1,347.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,527.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,527.45
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$2,078.25 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,679.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,833.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,435.22
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,589.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,078.25
|
| Rate for Payer: Dignity Health Senior |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,589.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,513.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,513.46
|
| Rate for Payer: IEHP Medi-Cal |
$181.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,178.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.25
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: IEHP Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: IEHP Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: IEHP Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Senior |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Senior |
$142.37
|
| Rate for Payer: IEHP Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Senior |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Senior |
$142.37
|
| Rate for Payer: IEHP Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Senior |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Senior |
$142.37
|
| Rate for Payer: IEHP Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
IP
|
$2,027.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.89 |
| Max. Negotiated Rate |
$1,520.25 |
| Rate for Payer: Adventist Health Commercial |
$405.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,392.55
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,372.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,372.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.75
|
| Rate for Payer: Multiplan Commercial |
$1,520.25
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
OP
|
$2,027.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.79 |
| Max. Negotiated Rate |
$1,520.25 |
| Rate for Payer: Adventist Health Commercial |
$405.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,392.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$403.70
|
| Rate for Payer: Blue Shield of California EPN |
$229.57
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,317.55
|
| 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 |
$1,317.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,254.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,254.71
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$129.79
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.75
|
| 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 |
$1,520.25
|
| 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 |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND CHEST
|
Facility
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$708.50
|
| 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 |
$708.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.71
|
| Rate for Payer: Heritage Provider Network Senior |
$674.71
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$82.95
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| 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 |
$817.50
|
| 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 |
$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 ULTRASOUND CHEST
|
Facility
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.83
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.93
|
| Rate for Payer: Heritage Provider Network Senior |
$737.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.75 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,147.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$291.67
|
| Rate for Payer: Blue Shield of California EPN |
$165.86
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,085.50
|
| 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 |
$1,085.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,033.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,033.73
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$94.75
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.50
|
| 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 |
$1,252.50
|
| 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 |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$302.27 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,147.29
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,130.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
|
|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$628.15 |
| Rate for Payer: Adventist Health Commercial |
$147.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$628.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$406.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$554.25
|
| Rate for Payer: Blue Shield of California Commercial |
$265.39
|
| Rate for Payer: Blue Shield of California EPN |
$150.92
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$480.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$628.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$628.15
|
| Rate for Payer: Dignity Health Senior |
$628.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$457.44
|
| Rate for Payer: Heritage Provider Network Senior |
$457.44
|
| Rate for Payer: IEHP Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$356.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.75
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| 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 |
$628.15
|
| Rate for Payer: Vantage Medical Group Senior |
$628.15
|
|
|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$554.25 |
| Rate for Payer: Adventist Health Commercial |
$147.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.69
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.30
|
| Rate for Payer: Heritage Provider Network Senior |
$500.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.75
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
IP
|
$1,368.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$939.82
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$926.14
|
| Rate for Payer: Heritage Provider Network Senior |
$926.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,026.00
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
OP
|
$1,368.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.02 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$223.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$939.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$754.55
|
| Rate for Payer: Blue Shield of California EPN |
$429.09
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$889.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.79
|
| Rate for Payer: Heritage Provider Network Senior |
$846.79
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$247.54
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
