|
HC ECG TRACING ONLY
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
905493005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.90
|
| Rate for Payer: BCBS Transplant Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$520.67
|
| Rate for Payer: Blue Shield of California EPN |
$413.19
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$660.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECHO-C 2D/M-MODE COMPLETE
|
Facility
IP
|
$2,439.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
900200204
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$585.36 |
| Max. Negotiated Rate |
$2,073.15 |
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.60
|
| Rate for Payer: Galaxy Health WC |
$2,073.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.36
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: Networks By Design Commercial |
$1,585.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,073.15
|
|
|
HC ECHO-C 2D/M-MODE COMPLETE
|
Facility
OP
|
$2,439.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
900200204
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$285.19 |
| Max. Negotiated Rate |
$2,073.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$692.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1,463.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,441.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,143.89
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Cigna of CA HMO |
$1,560.96
|
| Rate for Payer: Cigna of CA PPO |
$1,804.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,073.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,463.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,829.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: Networks By Design Commercial |
$1,585.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,073.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,463.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,463.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,463.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC ECHO-C CONG 2D COMPLETE CONGEN
|
Facility
IP
|
$3,155.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
900200225
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$757.20 |
| Max. Negotiated Rate |
$2,681.75 |
| Rate for Payer: Cash Price |
$1,419.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.00
|
| Rate for Payer: Galaxy Health WC |
$2,681.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,893.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,104.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,202.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.20
|
| Rate for Payer: Multiplan Commercial |
$2,524.00
|
| Rate for Payer: Networks By Design Commercial |
$2,050.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,681.75
|
|
|
HC ECHO-C CONG 2D COMPLETE CONGEN
|
Facility
OP
|
$3,155.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
900200225
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$290.04 |
| Max. Negotiated Rate |
$2,681.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$992.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,879.75
|
| Rate for Payer: BCBS Transplant Transplant |
$1,893.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,864.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,479.70
|
| Rate for Payer: Cash Price |
$1,419.75
|
| Rate for Payer: Cash Price |
$1,419.75
|
| Rate for Payer: Cash Price |
$1,419.75
|
| Rate for Payer: Cigna of CA HMO |
$2,019.20
|
| Rate for Payer: Cigna of CA PPO |
$2,334.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$2,681.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,893.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,366.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: IEHP Medi-Cal |
$1,116.63
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,104.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$2,524.00
|
| Rate for Payer: Networks By Design Commercial |
$2,050.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,681.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,893.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,893.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,893.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO-C DOPPLER COMPLETE
|
Facility
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
900200205
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$145.48 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$296.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,389.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$899.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$899.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$974.13
|
| Rate for Payer: BCBS Transplant Transplant |
$981.00
|
| Rate for Payer: Blue Shield of California Commercial |
$966.28
|
| Rate for Payer: Blue Shield of California EPN |
$766.82
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Dignity Health Media |
$1,389.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,389.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,226.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$981.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,389.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,389.75
|
|
|
HC ECHO-C DOPPLER COMPLETE
|
Facility
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
900200205
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.96
|
| Rate for Payer: BCBS Transplant Transplant |
$1,205.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.32
|
| Rate for Payer: Blue Shield of California EPN |
$942.22
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO |
$1,285.76
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,506.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ECHO CHD TEE IMG ACQ, INT AND RPT ONLY
|
Facility
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
900200317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$485.76 |
| Max. Negotiated Rate |
$1,720.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$637.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,720.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,113.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,113.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.90
|
| Rate for Payer: BCBS Transplant Transplant |
$1,214.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,196.18
|
| Rate for Payer: Blue Shield of California EPN |
$949.26
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Dignity Health Media |
$1,720.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,720.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,720.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,720.40
|
|
|
HC ECHO CHD TEE IMG ACQ, INT AND RPT ONLY
|
Facility
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
900200317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$485.76 |
| Max. Negotiated Rate |
$1,720.40 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC ECHO CHD TEE TRANSESOPHAGEAL
|
Facility
IP
|
$4,509.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
900200227
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,082.16 |
| Max. Negotiated Rate |
$3,832.65 |
| Rate for Payer: Cash Price |
$2,029.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,803.60
|
| Rate for Payer: Galaxy Health WC |
$3,832.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,705.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,007.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,717.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.16
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: Networks By Design Commercial |
$2,930.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,832.65
|
|
|
HC ECHO CHD TEE TRANSESOPHAGEAL
|
Facility
OP
|
$4,509.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
900200227
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$367.14 |
| Max. Negotiated Rate |
$3,875.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,875.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,686.46
|
| Rate for Payer: BCBS Transplant Transplant |
$2,705.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,664.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,114.72
|
| Rate for Payer: Cash Price |
$2,029.05
|
| Rate for Payer: Cash Price |
$2,029.05
|
| Rate for Payer: Cash Price |
$2,029.05
|
| Rate for Payer: Cigna of CA HMO |
$2,885.76
|
| Rate for Payer: Cigna of CA PPO |
$3,336.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$3,832.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,705.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,381.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: IEHP Medi-Cal |
$1,116.63
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,007.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: Networks By Design Commercial |
$2,930.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,832.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,705.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,705.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,705.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO COLOR FLOW MAPPING DOPPLE
|
Facility
IP
|
$1,353.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
900200208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$879.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
|
|
HC ECHO COLOR FLOW MAPPING DOPPLE
|
Facility
OP
|
$1,353.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
900200208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$219.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$744.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$806.12
|
| Rate for Payer: BCBS Transplant Transplant |
$811.80
|
| Rate for Payer: Blue Shield of California Commercial |
$799.62
|
| Rate for Payer: Blue Shield of California EPN |
$634.56
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cigna of CA HMO |
$865.92
|
| Rate for Payer: Cigna of CA PPO |
$1,001.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Media |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,014.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Networks By Design Commercial |
$879.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC ECHO-F 2D/M-MODE FOLLOWUP
|
Facility
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
900200209
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$590.16 |
| Max. Negotiated Rate |
$2,090.15 |
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.60
|
| Rate for Payer: Galaxy Health WC |
$2,090.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,475.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,640.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.16
|
| Rate for Payer: Multiplan Commercial |
$1,967.20
|
| Rate for Payer: Networks By Design Commercial |
$1,598.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,090.15
|
|
