|
HC ECHO-F DOPPLER FOLLOWUP
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
900200210
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$129.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,083.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$701.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$701.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$753.27
|
| Rate for Payer: Blue Distinction Transplant |
$765.00
|
| Rate for Payer: Blue Shield of California Commercial |
$787.95
|
| Rate for Payer: Blue Shield of California EPN |
$619.65
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.00
|
| Rate for Payer: Cigna of CA HMO |
$816.00
|
| Rate for Payer: Cigna of CA PPO |
$943.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,083.75
|
| Rate for Payer: Dignity Health Media |
$1,083.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,083.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,147.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$956.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$850.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$956.25
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
| Rate for Payer: Riverside University Health System MISP |
$510.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,083.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,083.75
|
|
|
HC ECHO-F FETAL 2D F/U
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
900200232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,030.95
|
| Rate for Payer: Blue Distinction Transplant |
$1,047.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,078.41
|
| Rate for Payer: Blue Shield of California EPN |
$848.07
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,308.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$566.19
|
| Rate for Payer: United Healthcare All Other HMO |
$566.19
|
| Rate for Payer: United Healthcare HMO Rider |
$566.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC ECHO-F FETAL 2D F/U
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
900200232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,570.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,163.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.00
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
|
HC ECHO-F FETAL DOPPLER F/U
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
900200234
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.20
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,420.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.60
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
|
|
HC ECHO-F FETAL DOPPLER F/U
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
900200234
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$932.28
|
| Rate for Payer: Blue Distinction Transplant |
$946.80
|
| Rate for Payer: Blue Shield of California Commercial |
$975.20
|
| Rate for Payer: Blue Shield of California EPN |
$766.91
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,009.92
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,420.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,183.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$946.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ECHO STRESS MONITORED
|
Facility
|
IP
|
$3,424.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
900200216
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$684.80 |
| Max. Negotiated Rate |
$3,081.60 |
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,369.60
|
| Rate for Payer: Galaxy Health WC |
$2,910.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,054.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,081.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,283.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,304.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.80
|
| Rate for Payer: Multiplan Commercial |
$2,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,225.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,910.40
|
|
|
HC ECHO STRESS MONITORED
|
Facility
|
OP
|
$3,424.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
900200216
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$182.63 |
| Max. Negotiated Rate |
$3,081.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$815.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$460.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,022.90
|
| Rate for Payer: Blue Distinction Transplant |
$2,054.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,116.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,664.06
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,739.20
|
| Rate for Payer: Cigna of CA HMO |
$2,191.36
|
| Rate for Payer: Cigna of CA PPO |
$2,533.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$2,910.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,054.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,081.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,568.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,137.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,283.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$2,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,225.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,910.40
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Riverside University Health System MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,054.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,054.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO STRESS TTE COMPLETE
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
900200249
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$469.85 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$945.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,508.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,229.68
|
| Rate for Payer: Blue Distinction Transplant |
$2,264.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,332.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,834.16
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Center for Health Promotion Commercial |
$490.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,019.20
|
| Rate for Payer: Cigna of CA HMO |
$2,415.36
|
| Rate for Payer: Cigna of CA PPO |
$2,792.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$3,207.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,264.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,396.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,830.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,137.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,517.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$2,830.50
|
| Rate for Payer: Networks By Design Commercial |
$2,453.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,207.90
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Riverside University Health System MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,264.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,264.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO STRESS TTE COMPLETE
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
900200249
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$754.80 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Cash Price |
$1,698.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,019.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Galaxy Health WC |
$3,207.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,264.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,396.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,517.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.80
|
| Rate for Payer: Multiplan Commercial |
$2,830.50
|
| Rate for Payer: Networks By Design Commercial |
$2,453.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,207.90
|
|
|
HC ECHO TEE W/CON 2D INT/RPT
|
Facility
|
OP
|
$3,134.00
|
|
|
Service Code
|
CPT C8925
|
| Hospital Charge Code |
900200244
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$626.80 |
| Max. Negotiated Rate |
$6,975.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,975.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,431.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,851.57
|
| Rate for Payer: Blue Distinction Transplant |
$1,880.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,936.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.12
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,410.30
|
| Rate for Payer: Cash Price |
$1,410.30
|
| Rate for Payer: Cash Price |
$1,410.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,507.20
|
| Rate for Payer: Cigna of CA HMO |
$2,005.76
|
| Rate for Payer: Cigna of CA PPO |
$2,319.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,663.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,880.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,820.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,350.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,090.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,350.50
|
| Rate for Payer: Networks By Design Commercial |
$2,037.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,663.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,880.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,880.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC ECHO TEE W/CON 2D INT/RPT
|
Facility
|
IP
|
$3,134.00
|
|
|
Service Code
|
CPT C8925
|
| Hospital Charge Code |
900200244
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$626.80 |
| Max. Negotiated Rate |
$2,820.60 |
| Rate for Payer: Cash Price |
$1,410.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,253.60
|
| Rate for Payer: Galaxy Health WC |
$2,663.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,880.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,820.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,090.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.80
|
| Rate for Payer: Multiplan Commercial |
$2,350.50
|
| Rate for Payer: Networks By Design Commercial |
$2,037.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,663.90
|
|
|
HC ECHO TEE W/CON CONGEN INT/RPT
|
Facility
|
OP
|
$2,507.00
|
|
|
Service Code
|
CPT C8926
|
| Hospital Charge Code |
900200245
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$23,619.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23,619.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,439.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.14
|
| Rate for Payer: Blue Distinction Transplant |
$1,504.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,549.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: Cigna of CA HMO |
$1,604.48
|
| Rate for Payer: Cigna of CA PPO |
$1,855.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,880.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC ECHO TEE W/CON CONGEN INT/RPT
|
Facility
|
IP
|
$2,507.00
|
|
|
Service Code
|
CPT C8926
|
| Hospital Charge Code |
900200245
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$2,256.30 |
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.80
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
|
|
HC ECHO TEE W/CON MONITOR 2D
|
Facility
|
OP
|
$2,507.00
|
|
|
Service Code
|
CPT C8927
|
| Hospital Charge Code |
900200246
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$2,722.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,722.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,213.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.14
|
| Rate for Payer: Blue Distinction Transplant |
$1,504.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,549.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: Cigna of CA HMO |
$1,604.48
|
| Rate for Payer: Cigna of CA PPO |
$1,855.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,880.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC ECHO TEE W/CON MONITOR 2D
|
Facility
|
IP
|
$2,507.00
|
|
|
Service Code
|
CPT C8927
|
| Hospital Charge Code |
900200246
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$2,256.30 |
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.80
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
|
|
HC ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$4,888.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
900200215
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$295.91 |
| Max. Negotiated Rate |
$4,399.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,297.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$844.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,887.83
|
| Rate for Payer: Blue Distinction Transplant |
$2,932.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,020.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,375.57
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,910.40
|
| Rate for Payer: Cigna of CA HMO |
$3,128.32
|
| Rate for Payer: Cigna of CA PPO |
$3,617.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$4,154.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,932.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,399.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,666.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,137.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,260.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$3,666.00
|
| Rate for Payer: Networks By Design Commercial |
$3,177.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,154.80
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Riverside University Health System MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,932.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,932.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$4,888.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
900200215
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$977.60 |
| Max. Negotiated Rate |
$4,399.20 |
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,955.20
|
| Rate for Payer: Galaxy Health WC |
$4,154.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,932.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,399.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,260.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,862.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.60
|
| Rate for Payer: Multiplan Commercial |
$3,666.00
|
| Rate for Payer: Networks By Design Commercial |
$3,177.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,154.80
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
|
OP
|
$9,586.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$367.19 |
| Max. Negotiated Rate |
$8,627.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,325.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,148.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,272.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,272.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,380.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,663.41
|
| Rate for Payer: Blue Distinction Transplant |
$5,751.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,924.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,658.80
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,668.80
|
| Rate for Payer: Cigna of CA HMO |
$6,135.04
|
| Rate for Payer: Cigna of CA PPO |
$7,093.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,148.10
|
| Rate for Payer: Dignity Health Media |
$8,148.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,834.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,834.40
|
| Rate for Payer: Galaxy Health WC |
$8,148.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,751.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,627.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,189.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,355.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,393.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.20
|
| Rate for Payer: Multiplan Commercial |
$7,189.50
|
| Rate for Payer: Networks By Design Commercial |
$6,230.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,148.10
|
| Rate for Payer: Riverside University Health System MISP |
$3,834.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,751.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,751.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,148.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,148.10
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
|
IP
|
$9,586.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,917.20 |
| Max. Negotiated Rate |
$8,627.40 |
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,668.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,834.40
|
| Rate for Payer: Galaxy Health WC |
$8,148.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,751.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,627.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,393.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.20
|
| Rate for Payer: Multiplan Commercial |
$7,189.50
|
| Rate for Payer: Networks By Design Commercial |
$6,230.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,148.10
|
|
|
HC ECHO TRANSTHO W/CON 2D COMPLET
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
CPT C8923
|
| Hospital Charge Code |
900200242
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$5,466.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,466.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,419.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,407.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,429.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,158.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,906.40
|
| Rate for Payer: Cigna of CA HMO |
$1,525.12
|
| Rate for Payer: Cigna of CA PPO |
$1,763.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,144.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,787.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$1,787.25
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC ECHO TRANSTHO W/CON 2D COMPLET
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
CPT C8923
|
| Hospital Charge Code |
900200242
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,144.70 |
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.20
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,144.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.60
|
| Rate for Payer: Multiplan Commercial |
$1,787.25
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
|
|
HC ECHO TRANSTHO W/CON 2D STRESS
|
Facility
|
OP
|
$2,507.00
|
|
|
Service Code
|
CPT C8928
|
| Hospital Charge Code |
900200247
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$18,299.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18,299.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,431.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.14
|
| Rate for Payer: Blue Distinction Transplant |
$1,504.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,549.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: Cigna of CA HMO |
$1,604.48
|
| Rate for Payer: Cigna of CA PPO |
$1,855.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,880.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC ECHO TRANSTHO W/CON 2D STRESS
|
Facility
|
IP
|
$2,507.00
|
|
|
Service Code
|
CPT C8928
|
| Hospital Charge Code |
900200247
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$2,256.30 |
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.80
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
|
|
HC ECHO TRANSTHO W/CON CONGEN F/U
|
Facility
|
IP
|
$2,507.00
|
|
|
Service Code
|
CPT C8922
|
| Hospital Charge Code |
900200241
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$2,256.30 |
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.80
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
|
|
HC ECHO TRANSTHO W/CON CONGEN F/U
|
Facility
|
OP
|
$2,507.00
|
|
|
Service Code
|
CPT C8922
|
| Hospital Charge Code |
900200241
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$501.40 |
| Max. Negotiated Rate |
$4,855.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,855.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,213.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.14
|
| Rate for Payer: Blue Distinction Transplant |
$1,504.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,549.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,218.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Cash Price |
$1,128.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,005.60
|
| Rate for Payer: Cigna of CA HMO |
$1,604.48
|
| Rate for Payer: Cigna of CA PPO |
$1,855.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,130.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,256.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,880.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,672.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$1,880.25
|
| Rate for Payer: Networks By Design Commercial |
$1,629.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,130.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,504.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,504.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
