|
HC EEG,AWAKE/DROWSY
|
Facility
|
OP
|
$2,236.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,631.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,332.21
|
| Rate for Payer: Blue Distinction Transplant |
$1,341.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,321.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,048.68
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cigna of CA HMO |
$1,431.04
|
| Rate for Payer: Cigna of CA PPO |
$1,654.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,900.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,341.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,677.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,491.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,788.80
|
| Rate for Payer: Networks By Design Commercial |
$1,453.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,900.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,341.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,341.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
IP
|
$2,236.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$536.64 |
| Max. Negotiated Rate |
$1,900.60 |
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$894.40
|
| Rate for Payer: Galaxy Health WC |
$1,900.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,341.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,491.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$851.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.64
|
| Rate for Payer: Multiplan Commercial |
$1,788.80
|
| Rate for Payer: Networks By Design Commercial |
$1,453.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,900.60
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$2,822.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,865.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,978.06
|
| Rate for Payer: Blue Distinction Transplant |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,962.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,557.08
|
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Cigna of CA HMO |
$2,124.80
|
| Rate for Payer: Cigna of CA PPO |
$2,456.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,822.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,490.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,656.00
|
| Rate for Payer: Networks By Design Commercial |
$2,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$796.80 |
| Max. Negotiated Rate |
$2,822.00 |
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.00
|
| Rate for Payer: Galaxy Health WC |
$2,822.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.80
|
| Rate for Payer: Multiplan Commercial |
$2,656.00
|
| Rate for Payer: Networks By Design Commercial |
$2,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.00
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,590.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.44
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$557.90
|
| Rate for Payer: Blue Shield of California EPN |
$442.74
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
OP
|
$5,119.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$4,351.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$809.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,351.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,815.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,815.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,049.90
|
| Rate for Payer: Blue Distinction Transplant |
$3,071.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,025.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,400.81
|
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Cigna of CA HMO |
$3,276.16
|
| Rate for Payer: Cigna of CA PPO |
$3,788.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,351.15
|
| Rate for Payer: Dignity Health Media |
$4,351.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,351.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,047.60
|
| Rate for Payer: Galaxy Health WC |
$4,351.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,071.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,839.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,414.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.56
|
| Rate for Payer: Multiplan Commercial |
$4,095.20
|
| Rate for Payer: Networks By Design Commercial |
$3,327.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,351.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,071.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,071.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,351.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,351.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,351.15
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
IP
|
$5,119.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,228.56 |
| Max. Negotiated Rate |
$4,351.15 |
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.60
|
| Rate for Payer: Galaxy Health WC |
$4,351.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,071.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,414.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.56
|
| Rate for Payer: Multiplan Commercial |
$4,095.20
|
| Rate for Payer: Networks By Design Commercial |
$3,327.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,351.15
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$1,960.95 |
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$922.80
|
| Rate for Payer: Galaxy Health WC |
$1,960.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,384.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,538.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.68
|
| Rate for Payer: Multiplan Commercial |
$1,845.60
|
| Rate for Payer: Networks By Design Commercial |
$1,499.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,960.95
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,384.20
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cigna of CA PPO |
$1,707.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,960.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,384.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,730.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,538.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,845.60
|
| Rate for Payer: Networks By Design Commercial |
$1,499.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,960.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,153.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG FOR ECS
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$303.84 |
| Max. Negotiated Rate |
$1,076.10 |
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.40
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
|
|
HC EEG FOR ECS
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$397.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$754.28
|
| Rate for Payer: Blue Distinction Transplant |
$759.60
|
| Rate for Payer: Blue Shield of California Commercial |
$748.21
|
| Rate for Payer: Blue Shield of California EPN |
$593.75
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna of CA HMO |
$810.24
|
| Rate for Payer: Cigna of CA PPO |
$936.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$949.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
OP
|
$3,815.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$211.55 |
| Max. Negotiated Rate |
$3,242.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,848.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,272.98
|
| Rate for Payer: Blue Distinction Transplant |
$2,289.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,789.24
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cigna of CA HMO |
$2,441.60
|
| Rate for Payer: Cigna of CA PPO |
$2,823.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,861.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$3,052.00
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,289.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,289.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
IP
|
$3,815.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$915.60 |
| Max. Negotiated Rate |
$3,242.75 |
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.00
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,453.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.60
|
| Rate for Payer: Multiplan Commercial |
$3,052.00
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,349.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.59
|
| Rate for Payer: Blue Distinction Transplant |
$601.80
|
| Rate for Payer: Blue Shield of California Commercial |
$592.77
|
| Rate for Payer: Blue Shield of California EPN |
$470.41
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$752.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
OP
|
$3,154.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,720.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,879.15
|
| Rate for Payer: Blue Distinction Transplant |
$1,892.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,864.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,479.23
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cigna of CA HMO |
$2,018.56
|
| Rate for Payer: Cigna of CA PPO |
$2,333.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,365.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,523.20
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,892.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,892.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
IP
|
$3,154.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$756.96 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.60
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.96
|
| Rate for Payer: Multiplan Commercial |
$2,523.20
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$3,307.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,307.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.44
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$557.90
|
| Rate for Payer: Blue Shield of California EPN |
$442.74
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,215.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$2,643.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,643.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.44
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$557.90
|
| Rate for Payer: Blue Shield of California EPN |
$442.74
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$226.56 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$635.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.44
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$557.90
|
| Rate for Payer: Blue Shield of California EPN |
$442.74
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$434.88 |
| Max. Negotiated Rate |
$6,610.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,610.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,079.59
|
| Rate for Payer: Blue Distinction Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,070.89
|
| Rate for Payer: Blue Shield of California EPN |
$849.83
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cigna of CA HMO |
$1,159.68
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,944.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
