|
HC ECHO-F 2D/M-MODE FOLLOWUP
|
Facility
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
900200209
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$2,090.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$537.68
|
| 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 |
$1,465.07
|
| Rate for Payer: BCBS Transplant Transplant |
$1,475.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,453.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,153.27
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cigna of CA HMO |
$1,573.76
|
| Rate for Payer: Cigna of CA PPO |
$1,819.66
|
| 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 |
$2,090.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,475.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,844.25
|
| 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 |
$1,640.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.16
|
| 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 |
$1,967.20
|
| Rate for Payer: Networks By Design Commercial |
$1,598.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,090.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,475.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,475.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,475.40
|
| 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-F CONG 2D F/U CONGENITAL
|
Facility
IP
|
$2,697.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
900200226
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$647.28 |
| Max. Negotiated Rate |
$2,292.45 |
| Rate for Payer: Cash Price |
$1,213.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,078.80
|
| Rate for Payer: Galaxy Health WC |
$2,292.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,618.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,027.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.28
|
| Rate for Payer: Multiplan Commercial |
$2,157.60
|
| Rate for Payer: Networks By Design Commercial |
$1,753.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,292.45
|
|
|
HC ECHO-F CONG 2D F/U CONGENITAL
|
Facility
OP
|
$2,697.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
900200226
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$2,292.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$661.78
|
| 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 |
$1,606.87
|
| Rate for Payer: BCBS Transplant Transplant |
$1,618.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,593.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,264.89
|
| Rate for Payer: Cash Price |
$1,213.65
|
| Rate for Payer: Cash Price |
$1,213.65
|
| Rate for Payer: Cash Price |
$1,213.65
|
| Rate for Payer: Cigna of CA HMO |
$1,726.08
|
| Rate for Payer: Cigna of CA PPO |
$1,995.78
|
| 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 |
$2,292.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,618.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,022.75
|
| 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 |
$1,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.28
|
| 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 |
$2,157.60
|
| Rate for Payer: Networks By Design Commercial |
$1,753.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,292.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,618.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,618.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,618.20
|
| 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-F DOPPLER FOLLOWUP
|
Facility
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
900200210
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$308.40 |
| Max. Negotiated Rate |
$1,092.25 |
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.00
|
| Rate for Payer: Galaxy Health WC |
$1,092.25
|
| Rate for Payer: Global Benefits Group Commercial |
$771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$857.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.40
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: Networks By Design Commercial |
$835.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,092.25
|
|
|
HC ECHO-F DOPPLER FOLLOWUP
|
Facility
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
900200210
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$1,092.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,092.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$706.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$706.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$765.60
|
| Rate for Payer: BCBS Transplant Transplant |
$771.00
|
| Rate for Payer: Blue Shield of California Commercial |
$759.44
|
| Rate for Payer: Blue Shield of California EPN |
$602.66
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna of CA HMO |
$822.40
|
| Rate for Payer: Cigna of CA PPO |
$950.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,092.25
|
| Rate for Payer: Dignity Health Media |
$1,092.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,092.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$514.00
|
| Rate for Payer: Galaxy Health WC |
$1,092.25
|
| Rate for Payer: Global Benefits Group Commercial |
$771.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$963.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$857.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.40
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: Networks By Design Commercial |
$835.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,092.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$771.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$771.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$771.00
|
| 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 |
$1,092.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,092.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,092.25
|
|
|
HC ECHO-F FETAL 2D F/U
|
Facility
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
900200232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$418.80 |
| Max. Negotiated Rate |
$1,483.25 |
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
|
HC ECHO-F FETAL 2D F/U
|
Facility
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
900200232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.47 |
| Max. Negotiated Rate |
$1,483.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$540.05
|
| 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 |
$1,039.67
|
| Rate for Payer: BCBS Transplant Transplant |
$1,047.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.30
|
| Rate for Payer: Blue Shield of California EPN |
$818.40
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| 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 |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,308.75
|
| 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 |
$1,163.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| 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 |
$1,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$566.19
|
| Rate for Payer: United Healthcare All Other HMO |
$566.19
|
| Rate for Payer: United Healthcare HMO Rider |
$566.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.19
|
| 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-F FETAL DOPPLER F/U
|
Facility
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
900200234
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$1,341.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$135.29
|
| 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 |
$940.17
|
| Rate for Payer: BCBS Transplant Transplant |
$946.80
|
| Rate for Payer: Blue Shield of California Commercial |
$932.60
|
| Rate for Payer: Blue Shield of California EPN |
$740.08
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA HMO |
$1,009.92
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| 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 |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,183.50
|
| 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 |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| 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 |
$1,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$946.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$946.80
|
| 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-F FETAL DOPPLER F/U
|
Facility
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
900200234
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$378.72 |
| Max. Negotiated Rate |
$1,341.30 |
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.20
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| Rate for Payer: Multiplan Commercial |
$1,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
|
|
HC ECHO TRANSESOPHAGEAL
|
Facility
OP
|
$4,928.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
900200215
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$295.91 |
| Max. Negotiated Rate |
$4,188.80 |
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,470.04
|
| 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 |
$2,936.10
|
| Rate for Payer: BCBS Transplant Transplant |
$2,956.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,311.23
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cigna of CA HMO |
$3,153.92
|
| Rate for Payer: Cigna of CA PPO |
$3,646.72
|
| 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 |
$4,188.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,956.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,696.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,286.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.72
|
| 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 |
$3,942.40
|
| Rate for Payer: Networks By Design Commercial |
$3,203.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,188.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,956.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,956.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,956.80
|
| 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 |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO TRANSESOPHAGEAL
|
Facility
IP
|
$4,928.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
900200215
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,182.72 |
| Max. Negotiated Rate |
$4,188.80 |
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,971.20
|
| Rate for Payer: Galaxy Health WC |
$4,188.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,956.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,286.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,877.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.72
|
| Rate for Payer: Multiplan Commercial |
$3,942.40
|
| Rate for Payer: Networks By Design Commercial |
$3,203.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,188.80
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
OP
|
$9,586.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$367.19 |
| Max. Negotiated Rate |
$8,148.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,501.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,148.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,272.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,272.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,711.34
|
| Rate for Payer: BCBS Transplant Transplant |
$5,751.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,665.33
|
| Rate for Payer: Blue Shield of California EPN |
$4,495.83
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cigna of CA HMO |
$6,135.04
|
| Rate for Payer: Cigna of CA PPO |
$7,093.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,148.10
|
| Rate for Payer: Dignity Health Media |
$8,148.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,834.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,834.40
|
| Rate for Payer: Galaxy Health WC |
$8,148.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,751.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,189.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,393.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.64
|
| Rate for Payer: Multiplan Commercial |
$7,668.80
|
| Rate for Payer: Networks By Design Commercial |
$6,230.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,148.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,751.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,751.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,751.60
|
| 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 |
$8,148.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,148.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,148.10
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
IP
|
$9,586.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,300.64 |
| Max. Negotiated Rate |
$8,148.10 |
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,834.40
|
| Rate for Payer: Galaxy Health WC |
$8,148.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,751.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,393.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.64
|
| Rate for Payer: Multiplan Commercial |
$7,668.80
|
| Rate for Payer: Networks By Design Commercial |
$6,230.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,148.10
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
OP
|
$4,909.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$455.54 |
| Max. Negotiated Rate |
$4,172.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,137.38
|
| 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 |
$2,924.78
|
| Rate for Payer: BCBS Transplant Transplant |
$2,945.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,901.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.32
|
| Rate for Payer: Cash Price |
$2,209.05
|
| Rate for Payer: Cash Price |
$2,209.05
|
| Rate for Payer: Cash Price |
$2,209.05
|
| Rate for Payer: Cigna of CA HMO |
$3,141.76
|
| Rate for Payer: Cigna of CA PPO |
$3,632.66
|
| 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 |
$4,172.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,945.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,681.75
|
| 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 |
$3,274.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.16
|
| 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 |
$3,927.20
|
| Rate for Payer: Networks By Design Commercial |
$3,190.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,172.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,945.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,945.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,945.40
|
| 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 TTE W DOPPLER COMPLETE
|
Facility
IP
|
$4,909.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,178.16 |
| Max. Negotiated Rate |
$4,172.65 |
| Rate for Payer: Cash Price |
$2,209.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,963.60
|
| Rate for Payer: Galaxy Health WC |
$4,172.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,945.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,274.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,870.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.16
|
| Rate for Payer: Multiplan Commercial |
$3,927.20
|
| Rate for Payer: Networks By Design Commercial |
$3,190.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,172.65
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
OP
|
$36,511.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$31,034.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,947.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31,034.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,081.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20,081.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$21,906.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26,908.61
|
| Rate for Payer: Blue Shield of California EPN |
$21,322.42
|
| Rate for Payer: Cash Price |
$16,429.95
|
| Rate for Payer: Cash Price |
$16,429.95
|
| Rate for Payer: Cash Price |
$16,429.95
|
| Rate for Payer: Cigna of CA HMO |
$23,367.04
|
| Rate for Payer: Cigna of CA PPO |
$27,018.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,034.35
|
| Rate for Payer: Dignity Health Media |
$31,034.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,034.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,604.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14,604.40
|
| Rate for Payer: Galaxy Health WC |
$31,034.35
|
| Rate for Payer: Global Benefits Group Commercial |
$21,906.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27,383.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,910.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,762.64
|
| Rate for Payer: Multiplan Commercial |
$29,208.80
|
| Rate for Payer: Networks By Design Commercial |
$23,732.15
|
| Rate for Payer: Prime Health Services Commercial |
$31,034.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21,906.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,906.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,906.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,034.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,034.35
|
| Rate for Payer: Vantage Medical Group Senior |
$31,034.35
|
|
|
HC ECMO CIRCUIT & SET-UP INITIAL
|
Facility
IP
|
$36,511.00
|
|
| Hospital Charge Code |
900190010
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$8,762.64 |
| Max. Negotiated Rate |
$31,034.35 |
| Rate for Payer: Cash Price |
$16,429.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,604.40
|
| Rate for Payer: Galaxy Health WC |
$31,034.35
|
| Rate for Payer: Global Benefits Group Commercial |
$21,906.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,910.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,762.64
|
| Rate for Payer: Multiplan Commercial |
$29,208.80
|
| Rate for Payer: Networks By Design Commercial |
$23,732.15
|
| Rate for Payer: Prime Health Services Commercial |
$31,034.35
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
IP
|
$984.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$236.16 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC ECMO EQUIP & MONITOR EA 4 HRS
|
Facility
OP
|
$984.00
|
|
| Hospital Charge Code |
900190021
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$236.16 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$645.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$836.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$541.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$541.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$590.40
|
| Rate for Payer: Blue Shield of California Commercial |
$725.21
|
| Rate for Payer: Blue Shield of California EPN |
$574.66
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.40
|
| Rate for Payer: Dignity Health Media |
$836.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$738.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.40
|
| Rate for Payer: Vantage Medical Group Senior |
$836.40
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
OP
|
$1,757.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$1,493.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,152.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,493.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$966.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,054.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,294.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.09
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cigna of CA HMO |
$1,124.48
|
| Rate for Payer: Cigna of CA PPO |
$1,300.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Dignity Health Media |
$1,493.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,493.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$702.80
|
| Rate for Payer: Galaxy Health WC |
$1,493.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,317.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.68
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: Networks By Design Commercial |
$1,142.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,493.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,054.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,493.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,493.45
|
|
|
HC ECMO RE-PRIME BLADDER
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
900190033
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$421.68 |
| Max. Negotiated Rate |
$1,493.45 |
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.80
|
| Rate for Payer: Galaxy Health WC |
$1,493.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.68
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: Networks By Design Commercial |
$1,142.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,493.45
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
IP
|
$821.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
|
|
HC ECMO RE-PRIME CANNULAE
|
Facility
OP
|
$821.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$538.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$451.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$492.60
|
| Rate for Payer: Blue Shield of California Commercial |
$605.08
|
| Rate for Payer: Blue Shield of California EPN |
$479.46
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cigna of CA HMO |
$525.44
|
| Rate for Payer: Cigna of CA PPO |
$607.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Media |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$615.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
OP
|
$13,248.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$11,260.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,689.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,260.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,286.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,286.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,948.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,763.78
|
| Rate for Payer: Blue Shield of California EPN |
$7,736.83
|
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: Cigna of CA HMO |
$8,478.72
|
| Rate for Payer: Cigna of CA PPO |
$9,803.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,260.80
|
| Rate for Payer: Dignity Health Media |
$11,260.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,299.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,299.20
|
| Rate for Payer: Galaxy Health WC |
$11,260.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,948.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,047.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$10,598.40
|
| Rate for Payer: Networks By Design Commercial |
$8,611.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,260.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,948.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,948.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,948.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,260.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,260.80
|
| Rate for Payer: Vantage Medical Group Senior |
$11,260.80
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
IP
|
$13,248.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$3,179.52 |
| Max. Negotiated Rate |
$11,260.80 |
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,299.20
|
| Rate for Payer: Galaxy Health WC |
$11,260.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,948.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,047.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$10,598.40
|
| Rate for Payer: Networks By Design Commercial |
$8,611.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,260.80
|
|
