|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$117.84 |
| Max. Negotiated Rate |
$417.35 |
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.40
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.84
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
|
|
HC ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$272.94
|
| 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 |
$234.15
|
| Rate for Payer: Blue Distinction Transplant |
$235.80
|
| Rate for Payer: Blue Shield of California Commercial |
$232.26
|
| Rate for Payer: Blue Shield of California EPN |
$184.32
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| 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 |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.75
|
| 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 |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.32
|
| 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 |
$314.40
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.32
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.00
|
| Rate for Payer: Galaxy Health WC |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
|
|
HC ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$139.18 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$384.29
|
| Rate for Payer: Blue Distinction Transplant |
$387.00
|
| Rate for Payer: Blue Shield of California Commercial |
$381.20
|
| Rate for Payer: Blue Shield of California EPN |
$302.50
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cigna of CA HMO |
$412.80
|
| Rate for Payer: Cigna of CA PPO |
$477.30
|
| 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 |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.75
|
| 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 |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| 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 |
$516.00
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 ELECTRON MICROSCOPY COMPLEX
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$228.48 |
| Max. Negotiated Rate |
$3,863.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,863.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.19
|
| Rate for Payer: Blue Distinction Transplant |
$571.20
|
| Rate for Payer: Blue Shield of California Commercial |
$614.99
|
| Rate for Payer: Blue Shield of California EPN |
$487.42
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
|
IP
|
$4,463.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,071.12 |
| Max. Negotiated Rate |
$3,793.55 |
| Rate for Payer: Cash Price |
$2,008.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.20
|
| Rate for Payer: Galaxy Health WC |
$3,793.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,976.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.12
|
| Rate for Payer: Multiplan Commercial |
$3,570.40
|
| Rate for Payer: Networks By Design Commercial |
$2,900.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,793.55
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
OP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,847.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cigna of CA HMO |
$3,037.44
|
| Rate for Payer: Cigna of CA PPO |
$3,512.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$4,034.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,847.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,559.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,438.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,408.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,408.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,165.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$997.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$3,796.80
|
| Rate for Payer: Networks By Design Commercial |
$3,084.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,034.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,847.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,847.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
IP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,139.04 |
| Max. Negotiated Rate |
$4,034.10 |
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,898.40
|
| Rate for Payer: Galaxy Health WC |
$4,034.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,847.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,165.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,808.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.04
|
| Rate for Payer: Multiplan Commercial |
$3,796.80
|
| Rate for Payer: Networks By Design Commercial |
$3,084.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,034.10
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
OP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,847.60
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cigna of CA PPO |
$3,512.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$4,034.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,847.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,559.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,438.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,438.66
|
| 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 |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,165.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$997.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$3,796.80
|
| Rate for Payer: Networks By Design Commercial |
$3,084.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,034.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,847.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,373.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,373.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,373.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
IP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,139.04 |
| Max. Negotiated Rate |
$4,034.10 |
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,898.40
|
| Rate for Payer: Galaxy Health WC |
$4,034.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,847.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,165.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,808.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.04
|
| Rate for Payer: Multiplan Commercial |
$3,796.80
|
| Rate for Payer: Networks By Design Commercial |
$3,084.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,034.10
|
|
|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN MCAL
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900400026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN MCAL
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900400026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN MCARE COMM
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900407032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN MCARE COMM
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900407032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.68 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$171.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: Dignity Health Media |
$242.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$213.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC ELECT STIM/RECRD BRAIN INTL HR
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
CPT 95961
|
| Hospital Charge Code |
900600401
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$682.91 |
| Max. Negotiated Rate |
$2,668.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$682.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,870.22
|
| Rate for Payer: Blue Distinction Transplant |
$1,883.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,855.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,472.19
|
| Rate for Payer: Cash Price |
$1,412.55
|
| Rate for Payer: Cash Price |
$1,412.55
|
| Rate for Payer: Cash Price |
$1,412.55
|
| Rate for Payer: Cigna of CA HMO |
$2,008.96
|
| Rate for Payer: Cigna of CA PPO |
$2,322.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$2,668.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,883.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,354.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,142.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,142.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,116.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,116.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,306.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,093.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,195.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,645.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: Networks By Design Commercial |
$2,040.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,668.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,883.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,883.40
|
| 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 |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC ELECT STIM/RECRD BRAIN INTL HR
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
CPT 95961
|
| Hospital Charge Code |
900600401
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$753.36 |
| Max. Negotiated Rate |
$2,668.15 |
| Rate for Payer: Cash Price |
$1,412.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,255.60
|
| Rate for Payer: Galaxy Health WC |
$2,668.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,883.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,093.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,195.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.36
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: Networks By Design Commercial |
$2,040.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,668.15
|
|
|
HC ELECT STIM/RECRD BRAIN SUB HR
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 95962
|
| Hospital Charge Code |
900600402
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$136.56 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$436.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$339.01
|
| Rate for Payer: Blue Distinction Transplant |
$341.40
|
| Rate for Payer: Blue Shield of California Commercial |
$336.28
|
| Rate for Payer: Blue Shield of California EPN |
$266.86
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cigna of CA HMO |
$364.16
|
| Rate for Payer: Cigna of CA PPO |
$421.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Media |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$426.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| 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 |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC ELECT STIM/RECRD BRAIN SUB HR
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 95962
|
| Hospital Charge Code |
900600402
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$136.56 |
| Max. Negotiated Rate |
$483.65 |
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.56
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
|
