|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,412.25 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$941.88
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,223.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,110.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,165.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,165.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$898.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$497.39 |
| Max. Negotiated Rate |
$2,335.80 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,698.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,511.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,061.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,374.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,341.02
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,786.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,335.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,621.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,701.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,701.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,310.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$497.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,923.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,335.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,335.80
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,099.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$1,574.25 |
| Rate for Payer: Adventist Health Commercial |
$419.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,351.76
|
| Rate for Payer: Cash Price |
$944.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,421.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.75
|
| Rate for Payer: Multiplan Commercial |
$1,574.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
OP
|
$2,099.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$1,784.15 |
| Rate for Payer: Adventist Health Commercial |
$419.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,297.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,574.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,049.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,280.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,024.31
|
| Rate for Payer: Cash Price |
$944.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,364.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,784.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,784.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,238.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,299.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,299.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,001.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,469.30
|
| Rate for Payer: Multiplan Commercial |
$1,574.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,049.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,049.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,784.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,784.15
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
908100555
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$497.39 |
| Max. Negotiated Rate |
$2,061.00 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,769.71
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,860.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,860.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$497.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.00
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN MC
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901300053
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN MCAL
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900400030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN MCARE COMM
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900407035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN OT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
901307035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
905103125
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC ULTRASOUND 15 MIN PT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
900417035
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
IP
|
$2,368.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$428.61 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Adventist Health Commercial |
$473.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,524.99
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,603.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,603.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$428.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$1,776.00
|
|
|
HC ULTRASOUND ABDOMINAL COMPLETE
|
Facility
|
OP
|
$2,368.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
906601146
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Adventist Health Commercial |
$473.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,463.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,184.47
|
| Rate for Payer: Blue Shield of California Commercial |
$415.82
|
| Rate for Payer: Blue Shield of California EPN |
$334.39
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,539.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,129.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$428.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND CHEST
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$954.75 |
| Rate for Payer: Adventist Health Commercial |
$254.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$786.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.75
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$572.85
|
| Rate for Payer: Cash Price |
$572.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$827.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$787.99
|
| Rate for Payer: Heritage Provider Network Senior |
$787.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$607.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$954.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND CHEST
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
906601525
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$954.75 |
| Rate for Payer: Adventist Health Commercial |
$254.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$819.81
|
| Rate for Payer: Cash Price |
$572.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$861.82
|
| Rate for Payer: Heritage Provider Network Senior |
$861.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.25
|
| Rate for Payer: Multiplan Commercial |
$954.75
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,463.25 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$975.89
|
| Rate for Payer: Blue Shield of California Commercial |
$300.43
|
| Rate for Payer: Blue Shield of California EPN |
$241.60
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,268.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,151.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,207.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,207.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$930.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND LIMITED SINGLE AREA
|
Facility
|
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
906601165
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$353.13 |
| Max. Negotiated Rate |
$1,463.25 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,256.44
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,320.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,320.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
|
|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$733.55 |
| Rate for Payer: Adventist Health Commercial |
$172.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$733.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$474.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.67
|
| Rate for Payer: Blue Shield of California Commercial |
$273.36
|
| Rate for Payer: Blue Shield of California EPN |
$219.83
|
| Rate for Payer: Cash Price |
$388.35
|
| Rate for Payer: Cash Price |
$388.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$560.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$733.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$733.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$733.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.20
|
| Rate for Payer: Heritage Provider Network Senior |
$534.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$411.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$604.10
|
| Rate for Payer: Multiplan Commercial |
$647.25
|
| 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 Commercial/Exchange |
$733.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$733.55
|
| Rate for Payer: Vantage Medical Group Senior |
$733.55
|
|
|
HC ULTRASOUND OB DETAILED ADDL FETUS
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
906601309
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$156.20 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Adventist Health Commercial |
$172.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.77
|
| Rate for Payer: Cash Price |
$388.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.25
|
| Rate for Payer: Heritage Provider Network Senior |
$584.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.75
|
| Rate for Payer: Multiplan Commercial |
$647.25
|
|
