|
HC URINE CHEM SCREEN POC
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.82
|
| Rate for Payer: Blue Shield of California Commercial |
$17.55
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.09
|
| Rate for Payer: Heritage Provider Network Senior |
$55.09
|
| Rate for Payer: Humana Medicare |
$2.25
|
| Rate for Payer: IEHP Medi-Cal |
$3.06
|
| Rate for Payer: IEHP Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
OP
|
$2,038.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,400.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.32
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.52
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$78.30
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
IP
|
$2,038.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.88 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,400.11
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,379.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,379.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
IP
|
$711.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$533.25 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.46
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$481.35
|
| Rate for Payer: Heritage Provider Network Senior |
$481.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.75
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
OP
|
$824.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.09
|
| Rate for Payer: 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 |
$511.70
|
| Rate for Payer: Blue Shield of California EPN |
$483.69
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.06
|
| Rate for Payer: Heritage Provider Network Senior |
$510.06
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$169.42
|
| 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 |
$149.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$618.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$412.00
|
| Rate for Payer: TriValley Medical Group Senior |
$412.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
OP
|
$711.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$533.25 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.46
|
| Rate for Payer: 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 |
$358.91
|
| Rate for Payer: Blue Shield of California EPN |
$204.10
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$462.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.11
|
| Rate for Payer: Heritage Provider Network Senior |
$440.11
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$169.42
|
| 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 |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
IP
|
$824.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.14 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.09
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.85
|
| Rate for Payer: Heritage Provider Network Senior |
$557.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Multiplan Commercial |
$618.00
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
IP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
OP
|
$370.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Blue Shield of California Commercial |
$184.35
|
| Rate for Payer: Blue Shield of California EPN |
$104.83
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Senior |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: IEHP Medi-Cal |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$366.14 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: 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 |
$366.14
|
| Rate for Payer: Blue Shield of California EPN |
$208.21
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$133.30
|
| 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 |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
OP
|
$914.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: 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 |
$366.14
|
| Rate for Payer: Blue Shield of California EPN |
$208.21
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$136.58
|
| 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 |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
IP
|
$914.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
OP
|
$914.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: 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 |
$428.91
|
| Rate for Payer: Blue Shield of California EPN |
$243.91
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$152.26
|
| 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 |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
IP
|
$914.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
OP
|
$458.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Blue Shield of California Commercial |
$186.31
|
| Rate for Payer: Blue Shield of California EPN |
$105.95
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$297.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Senior |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$283.50
|
| Rate for Payer: Heritage Provider Network Senior |
$283.50
|
| Rate for Payer: IEHP Medi-Cal |
$83.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.50
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
IP
|
$458.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$343.50 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.65
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.07
|
| Rate for Payer: Heritage Provider Network Senior |
$310.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.50
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
IP
|
$1,304.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Adventist Health Commercial |
$260.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.85
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.81
|
| Rate for Payer: Heritage Provider Network Senior |
$882.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.00
|
| Rate for Payer: Multiplan Commercial |
$978.00
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
OP
|
$1,304.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$1,108.40 |
| Rate for Payer: Adventist Health Commercial |
$260.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,108.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$717.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$978.00
|
| Rate for Payer: Blue Shield of California Commercial |
$311.24
|
| Rate for Payer: Blue Shield of California EPN |
$176.99
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$847.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,108.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,108.40
|
| Rate for Payer: Dignity Health Senior |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$847.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$807.18
|
| Rate for Payer: Heritage Provider Network Senior |
$807.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$628.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.00
|
| Rate for Payer: Multiplan Commercial |
$978.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,108.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,108.40
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
OP
|
$1,304.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$1,108.40 |
| Rate for Payer: Adventist Health Commercial |
$260.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,108.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$717.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$978.00
|
| Rate for Payer: Blue Shield of California Commercial |
$311.24
|
| Rate for Payer: Blue Shield of California EPN |
$176.99
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$847.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,108.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,108.40
|
| Rate for Payer: Dignity Health Senior |
$1,108.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$847.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$807.18
|
| Rate for Payer: Heritage Provider Network Senior |
$807.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$628.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.00
|
| Rate for Payer: Multiplan Commercial |
$978.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,108.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,108.40
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
IP
|
$1,304.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Adventist Health Commercial |
$260.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.85
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.81
|
| Rate for Payer: Heritage Provider Network Senior |
$882.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.00
|
| Rate for Payer: Multiplan Commercial |
$978.00
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.30 |
| Max. Negotiated Rate |
$1,140.75 |
| Rate for Payer: Adventist Health Commercial |
$304.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,044.93
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,029.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,029.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.25
|
| Rate for Payer: Multiplan Commercial |
$1,140.75
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Adventist Health Commercial |
$304.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,044.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,292.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$836.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,140.75
|
| Rate for Payer: Blue Shield of California Commercial |
$312.13
|
| Rate for Payer: Blue Shield of California EPN |
$177.50
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$988.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,292.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,292.85
|
| Rate for Payer: Dignity Health Senior |
$1,292.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$941.50
|
| Rate for Payer: Heritage Provider Network Senior |
$941.50
|
| Rate for Payer: IEHP Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$733.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.25
|
| Rate for Payer: Multiplan Commercial |
$1,140.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,292.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.85
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Adventist Health Commercial |
$304.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,044.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,292.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$836.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,140.75
|
| Rate for Payer: Blue Shield of California Commercial |
$312.13
|
| Rate for Payer: Blue Shield of California EPN |
$177.50
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$988.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,292.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,292.85
|
| Rate for Payer: Dignity Health Senior |
$1,292.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$941.50
|
| Rate for Payer: Heritage Provider Network Senior |
$941.50
|
| Rate for Payer: IEHP Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$733.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.25
|
| Rate for Payer: Multiplan Commercial |
$1,140.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,292.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.85
|
|
