|
HC ECG 48 HR MONITOR-SCANNING
|
Facility
IP
|
$1,702.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
900200114
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$308.06 |
| Max. Negotiated Rate |
$1,276.50 |
| Rate for Payer: Adventist Health Commercial |
$340.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,169.27
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,152.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,152.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.50
|
| Rate for Payer: Multiplan Commercial |
$1,276.50
|
|
|
HC ECG 48 HR MONITOR-SCANNING
|
Facility
OP
|
$1,702.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
900200114
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$1,276.50 |
| Rate for Payer: Adventist Health Commercial |
$340.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,169.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$449.08
|
| Rate for Payer: Blue Shield of California EPN |
$255.38
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cash Price |
$765.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,106.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,106.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,053.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,053.54
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$87.27
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$1,276.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,108.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$932.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG SIGNAL AVERAGE
|
Facility
IP
|
$961.00
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
900200141
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$173.94 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.21
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$650.60
|
| Rate for Payer: Heritage Provider Network Senior |
$650.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.25
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
|
|
HC ECG SIGNAL AVERAGE
|
Facility
OP
|
$961.00
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
900200141
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$240.97
|
| Rate for Payer: Blue Shield of California EPN |
$137.03
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.86
|
| Rate for Payer: Heritage Provider Network Senior |
$594.86
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$41.98
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
906593005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC ECG TRACING ONLY
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
906593005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.58
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC ECHO-C FETAL 2D COMPLETE
|
Facility
IP
|
$3,072.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
900200231
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$556.03 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Adventist Health Commercial |
$614.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,110.46
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,079.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,079.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.00
|
| Rate for Payer: Multiplan Commercial |
$2,304.00
|
|
|
HC ECHO-C FETAL 2D COMPLETE
|
Facility
OP
|
$3,072.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
900200231
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Adventist Health Commercial |
$614.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$303.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,110.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Blue Shield of California Commercial |
$403.70
|
| Rate for Payer: Blue Shield of California EPN |
$229.57
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,996.80
|
| 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 |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,901.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,901.57
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$127.11
|
| Rate for Payer: 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 |
$556.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.00
|
| 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 |
$2,304.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$353.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$353.87
|
| 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-C FETAL DOPPLER COMPLETE
|
Facility
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$363.63 |
| Max. Negotiated Rate |
$1,506.75 |
| Rate for Payer: Adventist Health Commercial |
$401.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,380.18
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,360.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,360.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.25
|
| Rate for Payer: Multiplan Commercial |
$1,506.75
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$1,506.75 |
| Rate for Payer: Adventist Health Commercial |
$401.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,380.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$356.12
|
| Rate for Payer: Blue Shield of California EPN |
$202.51
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,305.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,305.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,243.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,243.57
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$89.81
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,506.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| 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 CONTRAST DEFINITY
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
912000220
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.59
|
| Rate for Payer: Blue Shield of California Commercial |
$369.50
|
| Rate for Payer: Blue Shield of California EPN |
$349.26
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Senior |
$505.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.30
|
| Rate for Payer: Heritage Provider Network Senior |
$368.30
|
| Rate for Payer: IEHP Medi-Cal |
$78.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| 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 |
$107.70 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.76
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.82
|
| Rate for Payer: Heritage Provider Network Senior |
$402.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
|
|
HC ECHO CONTRAST OPTISON
|
Facility
OP
|
$737.00
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
912000219
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$47.61 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.28
|
| Rate for Payer: Blue Shield of California Commercial |
$457.68
|
| Rate for Payer: Blue Shield of California EPN |
$432.62
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Senior |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.20
|
| Rate for Payer: Heritage Provider Network Senior |
$456.20
|
| Rate for Payer: IEHP Medi-Cal |
$47.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC ECHO CONTRAST OPTISON
|
Facility
IP
|
$737.00
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
912000219
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.95
|
| Rate for Payer: Heritage Provider Network Senior |
$498.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
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 |
$315.84 |
| Max. Negotiated Rate |
$1,308.75 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,198.82
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,181.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,181.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.25
|
| Rate for Payer: Multiplan Commercial |
$1,308.75
|
|
