|
HC ECG TRACING ONLY RSPC EC
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$815.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: EPIC Health Plan Senior |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$687.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$815.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: EPIC Health Plan Senior |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$687.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.89
|
| 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 Exchange |
$114.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.68
|
| Rate for Payer: Blue Shield of California Commercial |
$733.95
|
| Rate for Payer: Blue Shield of California EPN |
$462.50
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Cigna of CA HMO |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$862.10
|
| 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 |
$815.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.77
|
| 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 |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$699.00
|
| 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
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.89
|
| 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 Exchange |
$114.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.68
|
| Rate for Payer: Blue Shield of California Commercial |
$733.95
|
| Rate for Payer: Blue Shield of California EPN |
$462.50
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Cigna of CA HMO |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$862.10
|
| 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 |
$815.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.77
|
| 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 |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$699.00
|
| 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
|
$1,165.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$815.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: EPIC Health Plan Senior |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$739.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$687.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC ECHO-C 2D/M-MODE COMPLETE
|
Facility
|
OP
|
$1,954.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
900200204
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$258.17 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$654.07
|
| 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 Exchange |
$998.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,136.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$775.74
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,563.20
|
| Rate for Payer: Cigna of CA HMO |
$1,250.56
|
| Rate for Payer: Cigna of CA PPO |
$1,445.96
|
| 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 |
$1,367.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,758.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$258.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,240.79
|
| 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 |
$390.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,465.50
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,172.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,172.40
|
| 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 2D/M-MODE COMPLETE
|
Facility
|
IP
|
$1,954.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
900200204
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,563.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,367.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.60
|
| Rate for Payer: EPIC Health Plan Senior |
$781.60
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,758.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,240.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,152.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.80
|
| Rate for Payer: Multiplan Commercial |
$1,465.50
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
|
|
HC ECHO-C CONG 2D COMPLETE CONGEN
|
Facility
|
OP
|
$2,527.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
900200225
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$2,274.30 |
| Rate for Payer: Adventist Health Commercial |
$505.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$937.29
|
| 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 Exchange |
$891.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,469.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,592.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,003.22
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,021.60
|
| Rate for Payer: Cigna of CA HMO |
$1,617.28
|
| Rate for Payer: Cigna of CA PPO |
$1,869.98
|
| 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 |
$1,768.90
|
| 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 |
$2,147.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,516.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,274.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$262.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,604.64
|
| 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 |
$505.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,895.25
|
| Rate for Payer: Networks By Design Commercial |
$1,642.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,147.95
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,516.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,516.20
|
| 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 CONG 2D COMPLETE CONGEN
|
Facility
|
IP
|
$2,527.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
900200225
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$2,274.30 |
| Rate for Payer: Adventist Health Commercial |
$505.40
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,021.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,768.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,010.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,010.80
|
| Rate for Payer: Galaxy Health WC |
$2,147.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,516.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,274.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,604.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,490.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.40
|
| Rate for Payer: Multiplan Commercial |
$1,895.25
|
| Rate for Payer: Networks By Design Commercial |
$1,642.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,147.95
|
|
|
HC ECHO-C DOPPLER COMPLETE
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
900200205
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
HC ECHO-C DOPPLER COMPLETE
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
900200205
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$131.70 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.03
|
| Rate for Payer: Blue Shield of California Commercial |
$825.30
|
| Rate for Payer: Blue Shield of California EPN |
$520.07
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$838.40
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$831.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$772.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| 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 |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC ECHO-C FETAL 2D COMPLETE
|
Facility
|
IP
|
$3,453.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
900200231
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$690.60 |
| Max. Negotiated Rate |
$3,107.70 |
| Rate for Payer: Adventist Health Commercial |
$690.60
|
| Rate for Payer: Cash Price |
$1,553.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,762.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.20
|
| Rate for Payer: Galaxy Health WC |
$2,935.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,107.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,192.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.60
|
| Rate for Payer: Multiplan Commercial |
$2,589.75
|
| Rate for Payer: Networks By Design Commercial |
$2,244.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.05
|
|
|
HC ECHO-C FETAL 2D COMPLETE
|
Facility
|
OP
|
$3,453.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
900200231
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.15 |
| Max. Negotiated Rate |
$3,107.70 |
| Rate for Payer: Adventist Health Commercial |
$690.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.99
|
| 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 Exchange |
$400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,008.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,175.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,370.84
|
| Rate for Payer: Cash Price |
$1,553.85
|
| Rate for Payer: Cash Price |
$1,553.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,762.40
|
| Rate for Payer: Cigna of CA HMO |
$2,209.92
|
| Rate for Payer: Cigna of CA PPO |
$2,555.22
|
| 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 |
$2,417.10
|
| 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 |
$2,935.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,107.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,192.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$2,589.75
|
| Rate for Payer: Networks By Design Commercial |
$2,244.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.05
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,071.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,071.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$566.19
|
| Rate for Payer: United Healthcare All Other HMO |
$566.19
|
| Rate for Payer: United Healthcare HMO Rider |
$566.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.19
|
| Rate for Payer: 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 FETAL DOPPLER COMPLETE
|
Facility
|
IP
|
$2,258.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$2,032.20 |
| Rate for Payer: Adventist Health Commercial |
$451.60
|
| Rate for Payer: Cash Price |
$1,016.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,806.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,580.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$903.20
|
| Rate for Payer: EPIC Health Plan Senior |
$903.20
|
| Rate for Payer: Galaxy Health WC |
$1,919.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,354.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,032.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,433.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,332.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.60
|
| Rate for Payer: Multiplan Commercial |
$1,693.50
|
| Rate for Payer: Networks By Design Commercial |
$1,467.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,919.30
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
|
OP
|
$2,258.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.02 |
| Max. Negotiated Rate |
$2,032.20 |
| Rate for Payer: Adventist Health Commercial |
$451.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| 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 Exchange |
$173.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,313.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,422.54
|
| Rate for Payer: Blue Shield of California EPN |
$896.43
|
| Rate for Payer: Cash Price |
$1,016.10
|
| Rate for Payer: Cash Price |
$1,016.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,806.40
|
| Rate for Payer: Cigna of CA HMO |
$1,445.12
|
| Rate for Payer: Cigna of CA PPO |
$1,670.92
|
| 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 |
$1,580.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,919.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,354.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,032.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,433.83
|
| 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 |
$451.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,693.50
|
| Rate for Payer: Networks By Design Commercial |
$1,467.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,919.30
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,354.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,354.80
|
| 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 CHD TEE IMG ACQ, INT AND RPT ONLY
|
Facility
|
OP
|
$1,621.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
900200317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$1,458.90 |
| Rate for Payer: Adventist Health Commercial |
$324.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$704.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$942.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,021.23
|
| Rate for Payer: Blue Shield of California EPN |
$643.54
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.80
|
| Rate for Payer: Cigna of CA HMO |
$1,037.44
|
| Rate for Payer: Cigna of CA PPO |
$1,199.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.40
|
| Rate for Payer: EPIC Health Plan Senior |
$648.40
|
| Rate for Payer: Galaxy Health WC |
$1,377.85
|
| Rate for Payer: Global Benefits Group Commercial |
$972.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,029.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$956.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.70
|
| Rate for Payer: Multiplan Commercial |
$1,215.75
|
| Rate for Payer: Networks By Design Commercial |
$1,053.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.85
|
| Rate for Payer: Riverside University Health System MISP |
$648.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.60
|
| 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 |
$1,377.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.85
|
|
|
HC ECHO CHD TEE IMG ACQ, INT AND RPT ONLY
|
Facility
|
IP
|
$1,621.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
900200317
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$1,458.90 |
| Rate for Payer: Adventist Health Commercial |
$324.20
|
| Rate for Payer: Cash Price |
$729.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.40
|
| Rate for Payer: EPIC Health Plan Senior |
$648.40
|
| Rate for Payer: Galaxy Health WC |
$1,377.85
|
| Rate for Payer: Global Benefits Group Commercial |
$972.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,029.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$956.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.20
|
| Rate for Payer: Multiplan Commercial |
$1,215.75
|
| Rate for Payer: Networks By Design Commercial |
$1,053.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.85
|
|
|
HC ECHO CHD TEE TRANSESOPHAGEAL
|
Facility
|
IP
|
$3,612.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
900200227
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$722.40 |
| Max. Negotiated Rate |
$3,250.80 |
| Rate for Payer: Adventist Health Commercial |
$722.40
|
| Rate for Payer: Cash Price |
$1,625.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,889.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,528.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,444.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,444.80
|
| Rate for Payer: Galaxy Health WC |
$3,070.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,167.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,250.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,293.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,131.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$722.40
|
| Rate for Payer: Multiplan Commercial |
$2,709.00
|
| Rate for Payer: Networks By Design Commercial |
$2,347.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,070.20
|
|
|
HC ECHO CHD TEE TRANSESOPHAGEAL
|
Facility
|
OP
|
$3,612.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
900200227
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$332.36 |
| Max. Negotiated Rate |
$3,661.11 |
| Rate for Payer: Adventist Health Commercial |
$722.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,661.11
|
| 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 Exchange |
$763.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,101.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,275.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.96
|
| Rate for Payer: Cash Price |
$1,625.40
|
| Rate for Payer: Cash Price |
$1,625.40
|
| Rate for Payer: Cash Price |
$1,625.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,889.60
|
| Rate for Payer: Cigna of CA HMO |
$2,311.68
|
| Rate for Payer: Cigna of CA PPO |
$2,672.88
|
| 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 |
$2,528.40
|
| 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 |
$3,070.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,167.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,250.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,293.62
|
| 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 |
$722.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$2,709.00
|
| Rate for Payer: Networks By Design Commercial |
$2,347.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,070.20
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,167.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,167.20
|
| 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
|
$1,084.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
900200208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$216.80 |
| Max. Negotiated Rate |
$975.60 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Central Health Plan Commercial |
$867.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$758.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.60
|
| Rate for Payer: EPIC Health Plan Senior |
$433.60
|
| Rate for Payer: Galaxy Health WC |
$921.40
|
| Rate for Payer: Global Benefits Group Commercial |
$650.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$975.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$639.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.80
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
| Rate for Payer: Networks By Design Commercial |
$704.60
|
| Rate for Payer: Prime Health Services Commercial |
$921.40
|
|
|
HC ECHO COLOR FLOW MAPPING DOPPLE
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
900200208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$133.95 |
| Max. Negotiated Rate |
$982.00 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$921.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$654.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.56
|
| Rate for Payer: Blue Shield of California Commercial |
$682.92
|
| Rate for Payer: Blue Shield of California EPN |
$430.35
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Central Health Plan Commercial |
$867.20
|
| Rate for Payer: Cigna of CA HMO |
$693.76
|
| Rate for Payer: Cigna of CA PPO |
$802.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$921.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$921.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$921.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$758.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.60
|
| Rate for Payer: EPIC Health Plan Senior |
$433.60
|
| Rate for Payer: Galaxy Health WC |
$921.40
|
| Rate for Payer: Global Benefits Group Commercial |
$650.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$975.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$639.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$758.80
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
| Rate for Payer: Networks By Design Commercial |
$704.60
|
| Rate for Payer: Prime Health Services Commercial |
$921.40
|
| Rate for Payer: Riverside University Health System MISP |
$433.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$650.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$650.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$921.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$921.40
|
| Rate for Payer: Vantage Medical Group Senior |
$921.40
|
|
|
HC ECHO CONTRAST DEFINITY
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
912000220
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$40.85 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.67
|
| Rate for Payer: Blue Shield of California Commercial |
$377.23
|
| Rate for Payer: Blue Shield of California EPN |
$237.41
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| Rate for Payer: Cigna of CA HMO |
$380.80
|
| Rate for Payer: Cigna of CA PPO |
$440.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
| Rate for Payer: Riverside University Health System MISP |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$297.50
|
| Rate for Payer: United Healthcare HMO Rider |
$297.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
|
HC ECHO CONTRAST DEFINITY
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
912000220
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Blue Shield of California Commercial |
$477.19
|
| Rate for Payer: Blue Shield of California EPN |
$299.88
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Central Health Plan Commercial |
$476.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.00
|
| Rate for Payer: EPIC Health Plan Senior |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$505.75
|
| Rate for Payer: Global Benefits Group Commercial |
$357.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$535.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Networks By Design Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Commercial |
$505.75
|
|
|
HC ECHO CONTRAST OPTISON
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
912000219
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Blue Shield of California Commercial |
$591.07
|
| Rate for Payer: Blue Shield of California EPN |
$371.45
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$515.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
|
|
HC ECHO CONTRAST OPTISON
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
912000219
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$40.85 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.49
|
| Rate for Payer: Blue Shield of California Commercial |
$467.26
|
| Rate for Payer: Blue Shield of California EPN |
$294.06
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA HMO |
$471.68
|
| Rate for Payer: Cigna of CA PPO |
$545.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$626.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$515.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Senior |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$368.50
|
| Rate for Payer: United Healthcare All Other HMO |
$368.50
|
| Rate for Payer: United Healthcare HMO Rider |
$368.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
