|
HC US GUID CHOR VILUS SAMP TWIN
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
910400116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA 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 GUIDE AMNIOCENTESIS
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$291.59 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,037.48
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
|
|
HC US GUIDE AMNIOCENTESIS
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.54 |
| Max. Negotiated Rate |
$1,369.35 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$995.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$886.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,208.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$805.82
|
| 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 |
$724.95
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,369.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,369.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.21
|
| Rate for Payer: Heritage Provider Network Senior |
$997.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$768.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,127.70
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$805.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$805.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,369.35
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.54 |
| Max. Negotiated Rate |
$1,369.35 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$995.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$886.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,208.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$805.82
|
| 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 |
$724.95
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,369.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,369.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.21
|
| Rate for Payer: Heritage Provider Network Senior |
$997.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$768.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,127.70
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$805.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$805.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,369.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,369.35
|
|
|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$291.59 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,037.48
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$732.23
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.75
|
| Rate for Payer: Heritage Provider Network Senior |
$769.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.25
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$702.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$625.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$852.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.73
|
| 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 |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$966.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$703.80
|
| Rate for Payer: Heritage Provider Network Senior |
$703.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$542.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$795.90
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$568.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.45
|
| Rate for Payer: Vantage Medical Group Senior |
$966.45
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.38 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,275.12
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,340.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,340.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.38 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,223.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,089.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,485.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.40
|
| Rate for Payer: Blue Shield of California Commercial |
$527.52
|
| Rate for Payer: Blue Shield of California EPN |
$424.21
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,683.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,683.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,168.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$944.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$990.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$990.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,683.00
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.38 |
| Max. Negotiated Rate |
$1,683.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,223.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,089.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,485.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.40
|
| Rate for Payer: Blue Shield of California Commercial |
$527.52
|
| Rate for Payer: Blue Shield of California EPN |
$424.21
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,683.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,683.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,168.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$944.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$990.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$990.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,683.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,683.00
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.38 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,275.12
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,340.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,340.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$692.75 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$448.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$611.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.66
|
| Rate for Payer: Blue Shield of California Commercial |
$89.18
|
| Rate for Payer: Blue Shield of California EPN |
$71.72
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$692.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$692.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.49
|
| Rate for Payer: Heritage Provider Network Senior |
$504.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$388.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$570.50
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$407.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$407.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$692.75
|
| Rate for Payer: Vantage Medical Group Senior |
$692.75
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.86
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.75
|
| Rate for Payer: Heritage Provider Network Senior |
$551.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$1,212.00 |
| Rate for Payer: Adventist Health Commercial |
$323.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.70
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,094.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,094.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.00
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$280.62 |
| Max. Negotiated Rate |
$1,373.60 |
| Rate for Payer: Adventist Health Commercial |
$323.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$998.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,373.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$888.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,212.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$808.32
|
| Rate for Payer: Blue Shield of California Commercial |
$348.96
|
| Rate for Payer: Blue Shield of California EPN |
$280.62
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,050.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,373.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,373.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,000.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$770.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,131.20
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$808.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$808.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,373.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,373.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,373.60
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$917.70
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$880.65
|
| 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 |
$712.78
|
| Rate for Payer: Blue Shield of California Commercial |
$512.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.13
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| 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 |
$840.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.08
|
| Rate for Payer: Heritage Provider Network Senior |
$882.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$679.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| 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 US SOFT TISS EXT LMTD
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$917.70
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: EPIC Health Plan Commercial |
$840.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$880.65
|
| 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 |
$712.78
|
| Rate for Payer: Blue Shield of California Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California EPN |
$48.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| 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: Heritage Provider Network Commercial |
$882.08
|
| Rate for Payer: Heritage Provider Network Senior |
$882.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$679.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| 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 US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,060.50 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.85
|
| 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 |
$707.28
|
| 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 |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$919.10
|
| 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 |
$834.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$875.27
|
| Rate for Payer: Heritage Provider Network Senior |
$875.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$674.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| 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 US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.93 |
| Max. Negotiated Rate |
$1,060.50 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$910.62
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$957.28
|
| Rate for Payer: Heritage Provider Network Senior |
$957.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
|
|
HC US TRANSRECTAL
|
Facility
|
IP
|
$1,841.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$333.22 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,185.60
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,246.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,246.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.25
|
| Rate for Payer: Multiplan Commercial |
$1,380.75
|
|
|
HC US TRANSRECTAL
|
Facility
|
OP
|
$1,841.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,137.74
|
| 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 |
$920.87
|
| Rate for Payer: Blue Shield of California Commercial |
$390.14
|
| Rate for Payer: Blue Shield of California EPN |
$313.74
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: Cash Price |
$828.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,196.65
|
| 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 |
$1,086.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,139.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,139.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$878.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,380.75
|
| 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 US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.89
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$441.40
|
| Rate for Payer: Heritage Provider Network Senior |
$441.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$1,389.12 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$402.94
|
| 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 |
$326.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,389.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.08
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$423.80
|
| 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 |
$384.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$403.59
|
| Rate for Payer: Heritage Provider Network Senior |
$403.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$311.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| 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 |
$322.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$322.78
|
| 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
|
|
