|
HC URINE CHEMISTRY SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.35
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.51
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| 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 CHEMISTRY SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.03
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.03
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.35
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.51
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| 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 UROGRAPHY ANTEGRADE
|
Facility
|
IP
|
$2,226.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.91 |
| Max. Negotiated Rate |
$1,669.50 |
| Rate for Payer: Adventist Health Commercial |
$445.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,433.54
|
| Rate for Payer: Cash Price |
$1,001.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,507.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,507.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.50
|
| Rate for Payer: Multiplan Commercial |
$1,669.50
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$2,226.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.91 |
| Max. Negotiated Rate |
$1,669.50 |
| Rate for Payer: Adventist Health Commercial |
$445.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,375.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.02
|
| 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 |
$1,001.70
|
| Rate for Payer: Cash Price |
$1,001.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,446.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,313.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,377.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,061.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,669.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| 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 |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$534.52
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.91
|
| Rate for Payer: Heritage Provider Network Senior |
$561.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.94
|
| 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 |
$415.17
|
| Rate for Payer: Blue Shield of California Commercial |
$369.70
|
| Rate for Payer: Blue Shield of California EPN |
$297.30
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$539.50
|
| 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 |
$489.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.77
|
| Rate for Payer: Heritage Provider Network Senior |
$513.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$395.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| 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 US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$538.90
|
| 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 |
$436.17
|
| Rate for Payer: Blue Shield of California Commercial |
$531.92
|
| Rate for Payer: Blue Shield of California EPN |
$425.54
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| 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 |
$514.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$539.77
|
| Rate for Payer: Heritage Provider Network Senior |
$539.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$415.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$436.00
|
| Rate for Payer: TriValley Medical Group Senior |
$436.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$436.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$436.00
|
| 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 US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$561.57
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$590.34
|
| Rate for Payer: Heritage Provider Network Senior |
$590.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.90
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Senior |
$281.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.08
|
| Rate for Payer: Blue Shield of California Commercial |
$189.89
|
| Rate for Payer: Blue Shield of California EPN |
$152.70
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$270.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$257.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$198.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| 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 |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$306.75 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.40
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.89
|
| Rate for Payer: Heritage Provider Network Senior |
$276.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$377.14 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.76
|
| 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 |
$204.58
|
| Rate for Payer: Blue Shield of California Commercial |
$377.14
|
| Rate for Payer: Blue Shield of California EPN |
$303.28
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$265.85
|
| 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 |
$241.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.17
|
| Rate for Payer: Heritage Provider Network Senior |
$253.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$195.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| 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 |
$180.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.30
|
| 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 US ABDOMINAL W CONTRAST
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.23
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$560.56
|
| Rate for Payer: Heritage Provider Network Senior |
$560.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
|
|
HC US ABDOMINAL W CONTRAST
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.17
|
| Rate for Payer: Blue Shield of California Commercial |
$505.08
|
| Rate for Payer: Blue Shield of California EPN |
$404.06
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$512.53
|
| Rate for Payer: Heritage Provider Network Senior |
$512.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$394.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$414.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$598.22
|
| 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 |
$484.19
|
| Rate for Payer: Blue Shield of California Commercial |
$377.14
|
| Rate for Payer: Blue Shield of California EPN |
$303.28
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$629.20
|
| 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 |
$571.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.19
|
| Rate for Payer: Heritage Provider Network Senior |
$599.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$461.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
| 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 |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| 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 US ELASTOGRAPHY 1ST TRGT LSN
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
906676982
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.21 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$623.39
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.34
|
| Rate for Payer: Heritage Provider Network Senior |
$655.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
|
|
HC US ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$598.22
|
| 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 |
$484.19
|
| Rate for Payer: Blue Shield of California Commercial |
$441.79
|
| Rate for Payer: Blue Shield of California EPN |
$355.27
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$629.20
|
| 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 |
$571.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.19
|
| Rate for Payer: Heritage Provider Network Senior |
$599.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$461.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
| 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 |
$180.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.02
|
| 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 US ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
906676981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.21 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Adventist Health Commercial |
$193.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$623.39
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.34
|
| Rate for Payer: Heritage Provider Network Senior |
$655.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.00
|
| Rate for Payer: Multiplan Commercial |
$726.00
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.70
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$327.67
|
| Rate for Payer: Heritage Provider Network Senior |
$327.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
|
|
HC US ELASTRGRPHY EA ADD TRGT LSN
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
906676983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.10
|
| Rate for Payer: Blue Shield of California Commercial |
$191.90
|
| Rate for Payer: Blue Shield of California EPN |
$154.32
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$411.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$411.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$411.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.60
|
| Rate for Payer: Heritage Provider Network Senior |
$299.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$230.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$338.80
|
| Rate for Payer: Multiplan Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$242.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$411.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$411.40
|
| Rate for Payer: Vantage Medical Group Senior |
$411.40
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$888.72
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.26
|
| Rate for Payer: Heritage Provider Network Senior |
$934.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
|
|
HC US GUID CHOR VILUS SAMPLING
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$852.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.28
|
| Rate for Payer: Blue Shield of California Commercial |
$320.59
|
| Rate for Payer: Blue Shield of California EPN |
$257.81
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$897.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,173.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$854.22
|
| Rate for Payer: Heritage Provider Network Senior |
$854.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$658.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$690.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.00
|
|
|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$888.72
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.26
|
| Rate for Payer: Heritage Provider Network Senior |
$934.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,035.00
|
|
