|
HC US ABDOMINAL W CONTRAST
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$442.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.08
|
| Rate for Payer: Blue Shield of California EPN |
$404.06
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Senior |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$512.53
|
| Rate for Payer: Heritage Provider Network Senior |
$512.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$394.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$579.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$414.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$517.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$665.02
|
| 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 |
$377.14
|
| Rate for Payer: Blue Shield of California EPN |
$303.28
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$629.20
|
| 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 |
$629.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.19
|
| Rate for Payer: Heritage Provider Network Senior |
$599.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$461.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| 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 |
$726.00
|
| 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 |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| 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 US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.21 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.34
|
| Rate for Payer: Heritage Provider Network Senior |
$655.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$517.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$665.02
|
| 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 |
$441.79
|
| Rate for Payer: Blue Shield of California EPN |
$355.27
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$629.20
|
| 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 |
$629.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.19
|
| Rate for Payer: Heritage Provider Network Senior |
$599.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$461.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| 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 |
$726.00
|
| 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 |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| 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 US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.21 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Cash Price |
$532.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.34
|
| Rate for Payer: Heritage Provider Network Senior |
$655.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$327.67
|
| Rate for Payer: Heritage Provider Network Senior |
$327.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$258.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$332.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$191.90
|
| Rate for Payer: Blue Shield of California EPN |
$154.32
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cash Price |
$266.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$411.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$411.40
|
| Rate for Payer: Dignity Health Senior |
$411.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.60
|
| Rate for Payer: Heritage Provider Network Senior |
$299.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$230.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.80
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$242.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$411.40
|
| Rate for Payer: Vantage Medical Group Senior |
$411.40
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$737.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.00
|
| Rate for Payer: Blue Shield of California Commercial |
$320.59
|
| Rate for Payer: Blue Shield of California EPN |
$257.81
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$897.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.00
|
| Rate for Payer: Dignity Health Senior |
$1,173.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$897.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$854.22
|
| Rate for Payer: Heritage Provider Network Senior |
$854.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$658.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$690.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.00
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.26
|
| Rate for Payer: Heritage Provider Network Senior |
$934.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.26
|
| Rate for Payer: Heritage Provider Network Senior |
$934.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$737.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.00
|
| Rate for Payer: Blue Shield of California Commercial |
$320.59
|
| Rate for Payer: Blue Shield of California EPN |
$257.81
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$897.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.00
|
| Rate for Payer: Dignity Health Senior |
$1,173.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$897.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$854.22
|
| Rate for Payer: Heritage Provider Network Senior |
$854.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$658.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$690.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.00
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$1,369.35 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$861.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$886.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,208.25
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$258.54
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,369.35
|
| Rate for Payer: Dignity Health Senior |
$1,369.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,047.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.21
|
| Rate for Payer: Heritage Provider Network Senior |
$997.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$768.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.70
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$805.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$805.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,369.35
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$291.59 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$1,369.35 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$861.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$886.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,208.25
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$258.54
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,369.35
|
| Rate for Payer: Dignity Health Senior |
$1,369.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,047.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.21
|
| Rate for Payer: Heritage Provider Network Senior |
$997.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$768.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,127.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,127.70
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$805.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$805.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,369.35
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$291.59 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.75
|
| Rate for Payer: Heritage Provider Network Senior |
$769.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.25
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$183.00 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$607.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$625.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$852.75
|
| Rate for Payer: Blue Shield of California Commercial |
$320.59
|
| Rate for Payer: Blue Shield of California EPN |
$257.81
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Cash Price |
$625.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.45
|
| Rate for Payer: Dignity Health Senior |
$966.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$703.80
|
| Rate for Payer: Heritage Provider Network Senior |
$703.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$542.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$795.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$795.90
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$568.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.45
|
| Rate for Payer: Vantage Medical Group Senior |
$966.45
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.38 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,340.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,340.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,058.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,360.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,089.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,485.00
|
| Rate for Payer: Blue Shield of California Commercial |
$527.52
|
| Rate for Payer: Blue Shield of California EPN |
$424.21
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,683.00
|
| Rate for Payer: Dignity Health Senior |
$1,683.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$944.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,386.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$990.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$990.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,683.00
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,058.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,360.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,089.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,485.00
|
| Rate for Payer: Blue Shield of California Commercial |
$527.52
|
| Rate for Payer: Blue Shield of California EPN |
$424.21
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,683.00
|
| Rate for Payer: Dignity Health Senior |
$1,683.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$944.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,386.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$990.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$990.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,683.00
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.38 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,340.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,340.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.48 |
| Max. Negotiated Rate |
$1,725.75 |
| Rate for Payer: Adventist Health Commercial |
$460.20
|
| Rate for Payer: Cash Price |
$1,265.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,557.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,557.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.25
|
| Rate for Payer: Multiplan Commercial |
$1,725.75
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.75
|
| Rate for Payer: Heritage Provider Network Senior |
$551.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$1,955.85 |
| Rate for Payer: Adventist Health Commercial |
$460.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,229.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,580.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.75
|
| Rate for Payer: Blue Shield of California Commercial |
$89.18
|
| Rate for Payer: Blue Shield of California EPN |
$71.72
|
| Rate for Payer: Cash Price |
$1,265.55
|
| Rate for Payer: Cash Price |
$1,265.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,495.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.85
|
| Rate for Payer: Dignity Health Senior |
$1,955.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,495.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,424.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,097.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.70
|
| Rate for Payer: Multiplan Commercial |
$1,725.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,150.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,150.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.85
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$692.75 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$435.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$448.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$611.25
|
| Rate for Payer: Blue Shield of California Commercial |
$89.18
|
| Rate for Payer: Blue Shield of California EPN |
$71.72
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$692.75
|
| Rate for Payer: Dignity Health Senior |
$692.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.49
|
| Rate for Payer: Heritage Provider Network Senior |
$504.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$570.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$570.50
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$407.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$407.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$692.75
|
| Rate for Payer: Vantage Medical Group Senior |
$692.75
|
|
