|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
IP
|
$1,599.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.42 |
| Max. Negotiated Rate |
$1,199.25 |
| Rate for Payer: Adventist Health Commercial |
$319.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,029.76
|
| Rate for Payer: Cash Price |
$719.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,082.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$289.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.75
|
| Rate for Payer: Multiplan Commercial |
$1,199.25
|
|
|
HC ULTRASOUND OB DETAILED SINGLE FETUS
|
Facility
|
OP
|
$1,599.00
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
906601310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.41 |
| Max. Negotiated Rate |
$1,199.25 |
| Rate for Payer: Adventist Health Commercial |
$319.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$988.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.82
|
| Rate for Payer: Blue Shield of California Commercial |
$777.22
|
| Rate for Payer: Blue Shield of California EPN |
$625.01
|
| Rate for Payer: Cash Price |
$719.55
|
| Rate for Payer: Cash Price |
$719.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,039.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$943.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$989.78
|
| Rate for Payer: Heritage Provider Network Senior |
$989.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$762.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$289.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,199.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC ULTRASOUND PELVIC
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,384.50 |
| Rate for Payer: Adventist Health Commercial |
$369.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,140.83
|
| 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 |
$923.37
|
| 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 |
$830.70
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,199.90
|
| 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 |
$1,089.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,142.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$880.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$334.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
| 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 PELVIC
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
906601203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$334.13 |
| Max. Negotiated Rate |
$1,384.50 |
| Rate for Payer: Adventist Health Commercial |
$369.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.82
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,249.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,249.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$334.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.50
|
| Rate for Payer: Multiplan Commercial |
$1,384.50
|
|
|
HC ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.21
|
| 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 |
$1,128.45
|
| 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 |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| 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 |
$1,331.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,396.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,396.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,076.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| 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 RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,452.86
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.05
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$761.99
|
| 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 |
$616.75
|
| 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 |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| 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 |
$727.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.23
|
| Rate for Payer: Heritage Provider Network Senior |
$763.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$588.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| 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 |
$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 TRANSVAGINAL
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.99
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
|
|
HC ULTRASOUND TRANSVAGINAL
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
906601205
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$690.92
|
| 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 |
$559.22
|
| 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 |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$726.70
|
| 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 |
$659.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.04
|
| Rate for Payer: Heritage Provider Network Senior |
$692.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$533.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| 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 TRANSVAGINAL OB
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.56
|
| 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 |
$371.15
|
| Rate for Payer: Blue Shield of California Commercial |
$315.70
|
| Rate for Payer: Blue Shield of California EPN |
$253.87
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| 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 |
$437.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.30
|
| Rate for Payer: Heritage Provider Network Senior |
$459.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| 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 TRANSVAGINAL OB
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.85
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.93
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.16
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$387.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC UNLISTED INVASIVE FETAL PROC ADD FETUS
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.93
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC UNLISTED INVASIVE FETAL PROC ADD FETUS
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.16
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$387.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC UNLISTED MODALITY PT
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$227.25 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.13
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.13
|
| Rate for Payer: Heritage Provider Network Senior |
$205.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
|
|
HC UNLISTED MODALITY PT
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
905103127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| 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 |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| 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 |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$124.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.25
|
| 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 |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$212.10
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| 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 |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC UNLISTED MODALITY PT COMM MCARE
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 97039
|
| Hospital Charge Code |
900417039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$227.25 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.13
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.13
|
| Rate for Payer: Heritage Provider Network Senior |
$205.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,328.36 |
| Max. Negotiated Rate |
$5,504.25 |
| Rate for Payer: Adventist Health Commercial |
$1,467.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,726.32
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.50
|
| Rate for Payer: Heritage Provider Network Senior |
$4,968.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,328.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,834.75
|
| Rate for Payer: Multiplan Commercial |
$5,504.25
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.24 |
| Max. Negotiated Rate |
$5,504.25 |
| Rate for Payer: Adventist Health Commercial |
$1,467.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,535.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,486.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,774.14
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Cash Price |
$3,302.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,770.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,770.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$408.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.50
|
| Rate for Payer: Heritage Provider Network Senior |
$4,968.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,500.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,328.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,834.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$5,504.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,403.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,403.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.00
|
| Rate for Payer: Blue Shield of California EPN |
$181.44
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$228.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Senior |
$288.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.46
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
