|
HC ECG TRACING ONLY
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
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 |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| 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 |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| 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 |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| 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 |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| 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 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: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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 |
$1,014.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,431.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,329.86
|
| 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 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 |
$741.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,446.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,438.05
|
| Rate for Payer: Blue Shield of California Commercial |
$948.93
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| 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/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$252.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,431.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| 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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
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 |
$1,312.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,041.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,851.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,720.44
|
| 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 |
$1,062.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,871.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,860.41
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| 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 |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,041.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| 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/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,851.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| 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 |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
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 |
$317.37
|
| 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 |
$969.61
|
| Rate for Payer: Blue Shield of California Commercial |
$964.02
|
| Rate for Payer: Blue Shield of California Commercial |
$636.13
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cash Price |
$679.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,057.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$959.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$891.49
|
| 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 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 |
$679.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,057.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$959.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$891.49
|
| 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 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 |
$275.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,407.25
|
| Rate for Payer: Blue Shield of California Commercial |
$923.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,399.13
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cash Price |
$986.85
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| 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/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,392.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC 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 |
$986.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,392.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,293.87
|
| 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 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 |
$841.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,188.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.89
|
| 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 |
$685.14
|
| 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 |
$1,200.62
|
| Rate for Payer: Blue Shield of California Commercial |
$787.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.70
|
| Rate for Payer: Cash Price |
$841.95
|
| Rate for Payer: Cash Price |
$841.95
|
| Rate for Payer: Cash Price |
$841.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,188.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$679.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.89
|
| 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 |
$1,875.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,917.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,646.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,459.12
|
| 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 |
$4,148.31 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,148.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,674.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,754.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2,659.18
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: Cash Price |
$1,875.60
|
| 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 |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| 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/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,646.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| 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 |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
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 |
$562.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$737.50
|
| 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 |
$234.64
|
| 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 |
$802.12
|
| Rate for Payer: Blue Shield of California Commercial |
$797.50
|
| Rate for Payer: Blue Shield of California Commercial |
$526.25
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$737.50
|
| 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
|
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 |
$575.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,458.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.17
|
| Rate for Payer: Blue Shield of California Commercial |
$956.93
|
| Rate for Payer: Cash Price |
$1,022.85
|
| Rate for Payer: Cash Price |
$1,022.85
|
| Rate for Payer: Cash Price |
$1,022.85
|
| 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 |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,591.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| 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/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,443.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| 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 |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
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 |
$1,022.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,591.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,443.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.07
|
| 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
|
|
