|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$460.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$460.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$127.20
|
| 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 |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$135.68
|
| Rate for Payer: Cigna of CA PPO |
$156.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Media |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| 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 |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.50
|
| Rate for Payer: Blue Distinction Transplant |
$193.20
|
| Rate for Payer: Blue Shield of California Commercial |
$208.01
|
| Rate for Payer: Blue Shield of California EPN |
$164.86
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$273.70
|
| Rate for Payer: Dignity Health Media |
$273.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$273.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.70
|
| Rate for Payer: Vantage Medical Group Senior |
$273.70
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| 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 |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$47.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.17
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$558.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.20
|
| Rate for Payer: Blue Distinction Transplant |
$142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.07
|
| Rate for Payer: Blue Shield of California EPN |
$111.15
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cigna of CA HMO |
$151.68
|
| Rate for Payer: Cigna of CA PPO |
$175.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$177.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$806.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$806.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.20
|
| 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 |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$201.45 |
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.80
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
|
|
HC MOTOR & SENS 11-12 NRV CNDJ TEST
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
900600329
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$298.08 |
| Max. Negotiated Rate |
$1,098.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$721.43
|
| 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 |
$739.98
|
| Rate for Payer: Blue Distinction Transplant |
$745.20
|
| Rate for Payer: Blue Shield of California Commercial |
$734.02
|
| Rate for Payer: Blue Shield of California EPN |
$582.50
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| 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 |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$931.50
|
| 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 |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.08
|
| 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 |
$993.60
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 11-12 NRV CNDJ TEST
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
900600329
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$298.08 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
|
HC MOTOR & SENS 1-2 NRV CNDJ TEST
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
900600324
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.94
|
| 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 |
$164.44
|
| Rate for Payer: Blue Distinction Transplant |
$165.60
|
| Rate for Payer: Blue Shield of California Commercial |
$163.12
|
| Rate for Payer: Blue Shield of California EPN |
$129.44
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$176.64
|
| Rate for Payer: Cigna of CA PPO |
$204.24
|
| 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 |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$207.00
|
| 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 |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| 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 |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 1-2 NRV CNDJ TEST
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
900600324
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
|
|
HC MOTOR & SENS 13 NRV CNDJ TEST
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
900600330
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.00
|
| Rate for Payer: Galaxy Health WC |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$870.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Networks By Design Commercial |
$848.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
|
|
HC MOTOR & SENS 13 NRV CNDJ TEST
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
900600330
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$806.39
|
| 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 |
$777.52
|
| Rate for Payer: Blue Distinction Transplant |
$783.00
|
| Rate for Payer: Blue Shield of California Commercial |
$771.26
|
| Rate for Payer: Blue Shield of California EPN |
$612.04
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cash Price |
$587.25
|
| Rate for Payer: Cigna of CA HMO |
$835.20
|
| Rate for Payer: Cigna of CA PPO |
$965.70
|
| 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 |
$1,109.25
|
| Rate for Payer: Global Benefits Group Commercial |
$783.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$978.75
|
| 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 |
$870.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| 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 |
$1,044.00
|
| Rate for Payer: Networks By Design Commercial |
$848.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,109.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 3-4 NRV CNDJ TEST
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
900600325
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$165.12 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$355.40
|
| 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 |
$409.91
|
| Rate for Payer: Blue Distinction Transplant |
$412.80
|
| Rate for Payer: Blue Shield of California Commercial |
$406.61
|
| Rate for Payer: Blue Shield of California EPN |
$322.67
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna of CA HMO |
$440.32
|
| Rate for Payer: Cigna of CA PPO |
$509.12
|
| 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 |
$584.80
|
| Rate for Payer: Global Benefits Group Commercial |
$412.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$516.00
|
| 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 |
$458.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.12
|
| 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 |
$550.40
|
| Rate for Payer: Networks By Design Commercial |
$447.20
|
| Rate for Payer: Prime Health Services Commercial |
$584.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$412.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$412.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 3-4 NRV CNDJ TEST
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
900600325
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$165.12 |
| Max. Negotiated Rate |
$584.80 |
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.20
|
| Rate for Payer: Galaxy Health WC |
$584.80
|
| Rate for Payer: Global Benefits Group Commercial |
$412.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$458.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.12
|
| Rate for Payer: Multiplan Commercial |
$550.40
|
| Rate for Payer: Networks By Design Commercial |
$447.20
|
| Rate for Payer: Prime Health Services Commercial |
$584.80
|
|
|
HC MOTOR & SENS 5-6 NRV CNDJ TEST
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
900600326
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$426.24
|
| 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 |
$361.65
|
| Rate for Payer: Blue Distinction Transplant |
$364.20
|
| Rate for Payer: Blue Shield of California Commercial |
$358.74
|
| Rate for Payer: Blue Shield of California EPN |
$284.68
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cigna of CA HMO |
$388.48
|
| Rate for Payer: Cigna of CA PPO |
$449.18
|
| 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 |
$515.95
|
| Rate for Payer: Global Benefits Group Commercial |
$364.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$455.25
|
| 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 |
$404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.68
|
| 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 |
$485.60
|
| Rate for Payer: Networks By Design Commercial |
$394.55
|
| Rate for Payer: Prime Health Services Commercial |
$515.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 5-6 NRV CNDJ TEST
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
900600326
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$515.95 |
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.80
|
| Rate for Payer: Galaxy Health WC |
$515.95
|
| Rate for Payer: Global Benefits Group Commercial |
$364.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.68
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: Networks By Design Commercial |
$394.55
|
| Rate for Payer: Prime Health Services Commercial |
$515.95
|
|
|
HC MOTOR & SENS 7-8 NRV CNDJ TEST
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
900600327
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$260.88 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
|
|
HC MOTOR & SENS 7-8 NRV CNDJ TEST
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
900600327
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$260.88 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$550.20
|
| 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 |
$647.63
|
| Rate for Payer: Blue Distinction Transplant |
$652.20
|
| Rate for Payer: Blue Shield of California Commercial |
$642.42
|
| Rate for Payer: Blue Shield of California EPN |
$509.80
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cigna of CA HMO |
$695.68
|
| Rate for Payer: Cigna of CA PPO |
$804.38
|
| 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 |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$815.25
|
| 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 |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| 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 |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$652.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 9-10 NRV CNDJ TEST
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
900600328
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$1,098.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$637.59
|
| 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 |
$704.83
|
| Rate for Payer: Blue Distinction Transplant |
$709.80
|
| Rate for Payer: Blue Shield of California Commercial |
$699.15
|
| Rate for Payer: Blue Shield of California EPN |
$554.83
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cigna of CA HMO |
$757.12
|
| Rate for Payer: Cigna of CA PPO |
$875.42
|
| 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 |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$887.25
|
| 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 |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| 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 |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$709.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| 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 MOTOR & SENS 9-10 NRV CNDJ TEST
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
900600328
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
OP
|
$6,019.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$630.86 |
| Max. Negotiated Rate |
$5,116.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,116.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,310.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,310.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,586.12
|
| Rate for Payer: Blue Distinction Transplant |
$3,611.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,557.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.91
|
| Rate for Payer: Cash Price |
$2,708.55
|
| Rate for Payer: Cash Price |
$2,708.55
|
| Rate for Payer: Cigna of CA HMO |
$3,852.16
|
| Rate for Payer: Cigna of CA PPO |
$4,454.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,116.15
|
| Rate for Payer: Dignity Health Media |
$5,116.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,116.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,407.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,407.60
|
| Rate for Payer: Galaxy Health WC |
$5,116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,611.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,514.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,014.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.56
|
| Rate for Payer: Multiplan Commercial |
$4,815.20
|
| Rate for Payer: Networks By Design Commercial |
$3,912.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,116.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,116.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,116.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,116.15
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
IP
|
$10,805.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,593.20 |
| Max. Negotiated Rate |
$9,184.25 |
| Rate for Payer: Cash Price |
$4,862.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,322.00
|
| Rate for Payer: Galaxy Health WC |
$9,184.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,206.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,116.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.20
|
| Rate for Payer: Multiplan Commercial |
$8,644.00
|
| Rate for Payer: Networks By Design Commercial |
$7,023.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,184.25
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$5,640.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$630.86 |
| Max. Negotiated Rate |
$4,794.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,102.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,360.31
|
| Rate for Payer: Blue Distinction Transplant |
$3,384.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,333.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,645.16
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cigna of CA HMO |
$3,609.60
|
| Rate for Payer: Cigna of CA PPO |
$4,173.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Dignity Health Media |
$4,794.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,256.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,256.00
|
| Rate for Payer: Galaxy Health WC |
$4,794.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,384.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,761.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.60
|
| Rate for Payer: Multiplan Commercial |
$4,512.00
|
| Rate for Payer: Networks By Design Commercial |
$3,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,794.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,384.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,384.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,794.00
|
|
