|
HC ECHO TEE W/CON MONITOR 2D
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT C8927
|
| Hospital Charge Code |
900200246
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
|
IP
|
$8,876.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,606.56 |
| Max. Negotiated Rate |
$6,657.00 |
| Rate for Payer: Adventist Health Commercial |
$1,775.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,097.81
|
| Rate for Payer: Cash Price |
$3,994.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,009.05
|
| Rate for Payer: Heritage Provider Network Senior |
$6,009.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,606.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.00
|
| Rate for Payer: Multiplan Commercial |
$6,657.00
|
|
|
HC ECHO TRANSESOPHAGEAL (TEE)
|
Facility
|
OP
|
$8,876.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
900293355
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$7,544.60 |
| Rate for Payer: Adventist Health Commercial |
$1,775.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$525.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,097.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,544.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,881.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,657.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,512.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,210.21
|
| Rate for Payer: Cash Price |
$3,994.20
|
| Rate for Payer: Cash Price |
$3,994.20
|
| Rate for Payer: Cash Price |
$3,994.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,769.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,544.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,544.60
|
| Rate for Payer: Dignity Health Senior |
$7,544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,769.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,494.24
|
| Rate for Payer: Heritage Provider Network Senior |
$5,494.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,278.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,606.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.00
|
| Rate for Payer: Multiplan Commercial |
$6,657.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,544.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7,544.60
|
|
|
HC ECHO TRANSTHO W/CON 2D COMPLET
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT C8923
|
| Hospital Charge Code |
900200242
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$2,167.01 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,167.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| 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: Blue Shield of California Commercial |
$1,307.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,235.64
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,368.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.00
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| 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
|
$2,105.00
|
|
|
Service Code
|
CPT C8923
|
| Hospital Charge Code |
900200242
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
|
|
HC ECHO TRANSTHO W/CON 2D STRESS
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT C8928
|
| Hospital Charge Code |
900200247
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$7,254.24 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,254.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| 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: Blue Shield of California Commercial |
$1,307.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,235.64
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,368.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.00
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| 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
|
$2,105.00
|
|
|
Service Code
|
CPT C8928
|
| Hospital Charge Code |
900200247
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
|
|
HC ECHO TRANSTHO W/CON CONGEN F/U
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT C8922
|
| Hospital Charge Code |
900200241
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$1,924.95 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,924.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| 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: Blue Shield of California Commercial |
$1,307.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,235.64
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,368.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.00
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| 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 CONGEN F/U
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT C8922
|
| Hospital Charge Code |
900200241
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
|
|
HC ECHO TRANSTHO W/CONT 2D/M-MODE
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT C8924
|
| Hospital Charge Code |
900200243
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
|
|
HC ECHO TRANSTHO W/CONT 2D/M-MODE
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT C8924
|
| Hospital Charge Code |
900200243
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,095.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,307.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,235.64
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,368.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$528.55
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ECHO TRANSTHO W/CONT COMPLETE
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT C8921
|
| Hospital Charge Code |
900200240
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$381.00 |
| Max. Negotiated Rate |
$1,578.75 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
|
|
HC ECHO TRANSTHO W/CONT COMPLETE
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT C8921
|
| Hospital Charge Code |
900200240
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$8,054.22 |
| Rate for Payer: Adventist Health Commercial |
$421.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,054.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.14
|
| 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: Blue Shield of California Commercial |
$1,307.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,235.64
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,368.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.00
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,578.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| 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 TTE W DOPPLER COMPLETE
|
Facility
|
IP
|
$3,360.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$608.16 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Adventist Health Commercial |
$672.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,308.32
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,274.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,274.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$2,520.00
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
OP
|
$3,360.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Adventist Health Commercial |
$672.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$397.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,308.32
|
| 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: Blue Shield of California Commercial |
$2,086.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,972.32
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,079.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,079.84
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$2,520.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$758.21
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| 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 ED EVAL & MGMT
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.93 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$996.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$476.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.02
|
| Rate for Payer: Dignity Health Senior |
$110.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$110.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.84
|
| Rate for Payer: Heritage Provider Network Senior |
$469.84
|
| Rate for Payer: Humana Medicare |
$110.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$110.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$334.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.77
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$251.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$231.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.93
|
|
|
HC ED EVAL & MGMT
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$476.78
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.84
|
| Rate for Payer: Heritage Provider Network Senior |
$469.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
IP
|
$3,738.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.58 |
| Max. Negotiated Rate |
$2,803.50 |
| Rate for Payer: Adventist Health Commercial |
$747.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,568.01
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,530.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,530.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.50
|
| Rate for Payer: Multiplan Commercial |
$2,803.50
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
OP
|
$3,738.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.58 |
| Max. Negotiated Rate |
$2,803.50 |
| Rate for Payer: Adventist Health Commercial |
$747.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,568.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,429.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: Dignity Health Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,429.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$802.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,530.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,530.63
|
| Rate for Payer: Humana Medicare |
$802.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,801.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$946.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,011.19
|
| Rate for Payer: Multiplan Commercial |
$2,803.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,357.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,248.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.53 |
| Max. Negotiated Rate |
$1,431.75 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,311.48
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,292.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,292.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.25
|
| Rate for Payer: Multiplan Commercial |
$1,431.75
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.53 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,364.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,311.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$534.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,240.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$534.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.14
|
| Rate for Payer: Dignity Health Senior |
$356.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$356.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,292.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,292.39
|
| Rate for Payer: Humana Medicare |
$356.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$356.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$920.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$420.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.18
|
| Rate for Payer: Multiplan Commercial |
$1,431.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$637.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$534.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.14
|
| Rate for Payer: Vantage Medical Group Senior |
$356.49
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.18
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$771.78
|
| Rate for Payer: Heritage Provider Network Senior |
$771.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$996.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$741.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.78
|
| Rate for Payer: Dignity Health Senior |
$204.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$204.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$771.78
|
| Rate for Payer: Heritage Provider Network Senior |
$771.78
|
| Rate for Payer: Humana Medicare |
$204.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$549.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.48
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$413.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.78
|
| Rate for Payer: Vantage Medical Group Senior |
$204.35
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$566.53 |
| Max. Negotiated Rate |
$2,347.50 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,150.31
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,119.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,119.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.50
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.39 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,150.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,034.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: Dignity Health Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,034.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$553.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,119.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,119.01
|
| Rate for Payer: Humana Medicare |
$553.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,508.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.27
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,136.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,045.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
