|
HC ECG TRACING ONLY RSPC CH
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.74
|
| Rate for Payer: Blue Shield of California Commercial |
$526.93
|
| Rate for Payer: Blue Shield of California EPN |
$347.84
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.74
|
| Rate for Payer: Blue Shield of California Commercial |
$526.93
|
| Rate for Payer: Blue Shield of California EPN |
$347.84
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.74
|
| Rate for Payer: Blue Shield of California Commercial |
$526.93
|
| Rate for Payer: Blue Shield of California EPN |
$347.84
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.74
|
| Rate for Payer: Blue Shield of California Commercial |
$526.93
|
| Rate for Payer: Blue Shield of California EPN |
$347.84
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC ECHO-C 2D/M-MODE COMPLETE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
900200204
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$252.17 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,478.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,384.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.45
|
| Rate for Payer: Blue Shield of California EPN |
$910.62
|
| Rate for Payer: Cash Price |
$1,239.70
|
| Rate for Payer: Cash Price |
$1,239.70
|
| Rate for Payer: Cash Price |
$1,239.70
|
| Rate for Payer: Cigna of CA HMO |
$1,442.56
|
| Rate for Payer: Cigna of CA PPO |
$1,667.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,915.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,352.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$252.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,503.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,803.20
|
| Rate for Payer: Networks By Design Commercial |
$1,465.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,352.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,352.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC ECHO-C 2D/M-MODE COMPLETE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
900200204
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Cash Price |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.60
|
| Rate for Payer: EPIC Health Plan Senior |
$901.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,352.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,503.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,395.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$1,803.20
|
| Rate for Payer: Networks By Design Commercial |
$1,465.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.90
|
|
|
HC ECHO-C CONG 2D COMPLETE CONGEN
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
900200225
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$2,478.60 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.40
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.84
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
|
|
HC ECHO-C CONG 2D COMPLETE CONGEN
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
900200225
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$256.45 |
| Max. Negotiated Rate |
$2,478.60 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,912.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,790.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,178.06
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cigna of CA HMO |
$1,866.24
|
| Rate for Payer: Cigna of CA PPO |
$2,157.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,749.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,749.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC ECHO-C DOPPLER COMPLETE
|
Facility
|
IP
|
$1,511.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
900200205
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$302.20 |
| Max. Negotiated Rate |
$1,284.35 |
| Rate for Payer: Adventist Health Commercial |
$302.20
|
| Rate for Payer: Cash Price |
$831.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.40
|
| Rate for Payer: EPIC Health Plan Senior |
$604.40
|
| Rate for Payer: Galaxy Health WC |
$1,284.35
|
| Rate for Payer: Global Benefits Group Commercial |
$906.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$935.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.64
|
| Rate for Payer: Multiplan Commercial |
$1,208.80
|
| Rate for Payer: Networks By Design Commercial |
$982.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,284.35
|
|
|
HC ECHO-C DOPPLER COMPLETE
|
Facility
|
OP
|
$1,511.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
900200205
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$128.64 |
| Max. Negotiated Rate |
$1,284.35 |
| Rate for Payer: Adventist Health Commercial |
$302.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$991.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,284.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$831.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,133.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$927.91
|
| Rate for Payer: Blue Shield of California Commercial |
$924.73
|
| Rate for Payer: Blue Shield of California EPN |
$610.44
|
| Rate for Payer: Cash Price |
$831.05
|
| Rate for Payer: Cash Price |
$831.05
|
| Rate for Payer: Cash Price |
$831.05
|
| Rate for Payer: Cigna of CA HMO |
$967.04
|
| Rate for Payer: Cigna of CA PPO |
$1,118.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,284.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,284.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,284.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.40
|
| Rate for Payer: EPIC Health Plan Senior |
$604.40
|
| Rate for Payer: Galaxy Health WC |
$1,284.35
|
| Rate for Payer: Global Benefits Group Commercial |
$906.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$935.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,057.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,057.70
|
| Rate for Payer: Multiplan Commercial |
$1,208.80
|
| Rate for Payer: Networks By Design Commercial |
$982.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,284.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$906.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$906.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,284.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,284.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,284.35
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Cash Price |
$1,206.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$877.20
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,357.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,438.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,342.12
|
| Rate for Payer: Blue Shield of California EPN |
$885.97
|
| Rate for Payer: Cash Price |
$1,206.15
|
| Rate for Payer: Cash Price |
$1,206.15
|
| Rate for Payer: Cigna of CA HMO |
$1,403.52
|
| Rate for Payer: Cigna of CA PPO |
$1,622.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.80
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ECHO CHD TEE IMG ACQ, INT AND RPT ONLY
|
Facility
|
IP
|
$1,871.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
900200317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$374.20 |
| Max. Negotiated Rate |
$1,590.35 |
| Rate for Payer: Adventist Health Commercial |
$374.20
|
| Rate for Payer: Cash Price |
$1,029.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$748.40
|
| Rate for Payer: Galaxy Health WC |
$1,590.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.04
|
| Rate for Payer: Multiplan Commercial |
$1,496.80
|
| Rate for Payer: Networks By Design Commercial |
$1,216.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,590.35
|
|
|
HC ECHO CHD TEE IMG ACQ, INT AND RPT ONLY
|
Facility
|
OP
|
$1,871.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
900200317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$374.20 |
| Max. Negotiated Rate |
$1,590.35 |
| Rate for Payer: Adventist Health Commercial |
$374.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,227.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,590.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,029.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,403.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,148.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.05
|
| Rate for Payer: Blue Shield of California EPN |
$755.88
|
| Rate for Payer: Cash Price |
$1,029.05
|
| Rate for Payer: Cash Price |
$1,029.05
|
| Rate for Payer: Cigna of CA HMO |
$1,197.44
|
| Rate for Payer: Cigna of CA PPO |
$1,384.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,590.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,590.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,590.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$748.40
|
| Rate for Payer: Galaxy Health WC |
$1,590.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,309.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,309.70
|
| Rate for Payer: Multiplan Commercial |
$1,496.80
|
| Rate for Payer: Networks By Design Commercial |
$1,216.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,590.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,590.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,590.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,590.35
|
|
|
HC ECHO CHD TEE TRANSESOPHAGEAL
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
900200227
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,542.80 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,579.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Multiplan Commercial |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC ECHO CHD TEE TRANSESOPHAGEAL
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
900200227
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.63 |
| Max. Negotiated Rate |
$3,542.80 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,733.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,559.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,550.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,683.87
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cigna of CA HMO |
$2,667.52
|
| Rate for Payer: Cigna of CA PPO |
$3,084.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,500.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,500.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC ECHO COLOR FLOW MAPPING DOPPLE
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
900200208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC ECHO COLOR FLOW MAPPING DOPPLE
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
900200208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$130.84 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$819.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$687.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.62
|
| Rate for Payer: Blue Shield of California Commercial |
$765.00
|
| Rate for Payer: Blue Shield of California EPN |
$505.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,062.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,062.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,062.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,062.50
|
|
|
HC ECHO-F 2D/M-MODE FOLLOWUP
|
Facility
|
IP
|
$2,273.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
900200209
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$454.60 |
| Max. Negotiated Rate |
$1,932.05 |
| Rate for Payer: Adventist Health Commercial |
$454.60
|
| Rate for Payer: Cash Price |
$1,250.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$909.20
|
| Rate for Payer: EPIC Health Plan Senior |
$909.20
|
| Rate for Payer: Galaxy Health WC |
$1,932.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,363.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,516.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,406.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.52
|
| Rate for Payer: Multiplan Commercial |
$1,818.40
|
| Rate for Payer: Networks By Design Commercial |
$1,477.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,932.05
|
|
|
HC ECHO-F 2D/M-MODE FOLLOWUP
|
Facility
|
OP
|
$2,273.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
900200209
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$1,932.05 |
| Rate for Payer: Adventist Health Commercial |
$454.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,490.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,395.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.08
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$1,250.15
|
| Rate for Payer: Cash Price |
$1,250.15
|
| Rate for Payer: Cash Price |
$1,250.15
|
| Rate for Payer: Cigna of CA HMO |
$1,454.72
|
| Rate for Payer: Cigna of CA PPO |
$1,682.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,932.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,363.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,516.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,818.40
|
| Rate for Payer: Networks By Design Commercial |
$1,477.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,932.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,363.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,363.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC ECHO-F CONG 2D F/U CONGENITAL
|
Facility
|
IP
|
$2,493.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
900200226
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$498.60 |
| Max. Negotiated Rate |
$2,119.05 |
| Rate for Payer: Adventist Health Commercial |
$498.60
|
| Rate for Payer: Cash Price |
$1,371.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$997.20
|
| Rate for Payer: Galaxy Health WC |
$2,119.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,662.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,543.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.32
|
| Rate for Payer: Multiplan Commercial |
$1,994.40
|
| Rate for Payer: Networks By Design Commercial |
$1,620.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,119.05
|
|
