|
HC NEEDLE ELEC LIMIT STUDY 1 SITE
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
900600255
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$263.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.17
|
| Rate for Payer: BCBS Transplant Transplant |
$176.40
|
| Rate for Payer: Blue Shield of California Commercial |
$173.75
|
| Rate for Payer: Blue Shield of California EPN |
$137.89
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$220.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC NEEDLE ELEC LIMIT STUDY 1 SITE
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
900600255
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC NEEDLE ELECT CRANI NERVE BI
|
Facility
IP
|
$761.00
|
|
|
Service Code
|
CPT 95868
|
| Hospital Charge Code |
900600253
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$182.64 |
| Max. Negotiated Rate |
$646.85 |
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.64
|
| Rate for Payer: Multiplan Commercial |
$608.80
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC NEEDLE ELECT CRANI NERVE BI
|
Facility
OP
|
$761.00
|
|
|
Service Code
|
CPT 95868
|
| Hospital Charge Code |
900600253
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.40
|
| Rate for Payer: BCBS Transplant Transplant |
$456.60
|
| Rate for Payer: Blue Shield of California Commercial |
$449.75
|
| Rate for Payer: Blue Shield of California EPN |
$356.91
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cigna of CA HMO |
$487.04
|
| Rate for Payer: Cigna of CA PPO |
$563.14
|
| 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 |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$570.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$608.80
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$456.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEEDLE ELEC THOR/SPINAL MUSC
|
Facility
IP
|
$368.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
900600254
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
|
|
HC NEEDLE ELEC THOR/SPINAL MUSC
|
Facility
OP
|
$368.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
900600254
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$49.86 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$270.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.25
|
| Rate for Payer: BCBS Transplant Transplant |
$220.80
|
| Rate for Payer: Blue Shield of California Commercial |
$217.49
|
| Rate for Payer: Blue Shield of California EPN |
$172.59
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| 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 |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$276.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| 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 |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEEDLE EMG 1 EXT W/ WO PARASP
|
Facility
IP
|
$2,803.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
900600233
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$672.72 |
| Max. Negotiated Rate |
$2,382.55 |
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,121.20
|
| Rate for Payer: Galaxy Health WC |
$2,382.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,681.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,869.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.72
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,382.55
|
|
|
HC NEEDLE EMG 1 EXT W/ WO PARASP
|
Facility
OP
|
$2,803.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
900600233
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$124.64 |
| Max. Negotiated Rate |
$2,382.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$279.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,670.03
|
| Rate for Payer: BCBS Transplant Transplant |
$1,681.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,656.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,314.61
|
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: Cash Price |
$1,261.35
|
| Rate for Payer: Cigna of CA HMO |
$1,793.92
|
| Rate for Payer: Cigna of CA PPO |
$2,074.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$2,382.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,681.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,102.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,869.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,382.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,681.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,681.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,681.80
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
OP
|
$3,503.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,977.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$357.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,087.09
|
| Rate for Payer: BCBS Transplant Transplant |
$2,101.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,070.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,642.91
|
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: Cigna of CA HMO |
$2,241.92
|
| Rate for Payer: Cigna of CA PPO |
$2,592.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$2,977.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,101.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,627.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$2,802.40
|
| Rate for Payer: Networks By Design Commercial |
$2,276.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,977.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,101.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,101.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,101.80
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
IP
|
$3,503.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$840.72 |
| Max. Negotiated Rate |
$2,977.55 |
| Rate for Payer: Cash Price |
$1,576.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.20
|
| Rate for Payer: Galaxy Health WC |
$2,977.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,101.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,334.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.72
|
| Rate for Payer: Multiplan Commercial |
$2,802.40
|
| Rate for Payer: Networks By Design Commercial |
$2,276.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,977.55
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
OP
|
$2,949.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$434.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,757.01
|
| Rate for Payer: BCBS Transplant Transplant |
$1,769.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,742.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,383.08
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO |
$1,887.36
|
| Rate for Payer: Cigna of CA PPO |
$2,182.26
|
| 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 |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,211.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| 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 |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,916.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
IP
|
$2,949.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$707.76 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,916.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
OP
|
$2,949.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$497.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,757.01
|
| Rate for Payer: BCBS Transplant Transplant |
$1,769.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,742.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,383.08
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO |
$1,887.36
|
| Rate for Payer: Cigna of CA PPO |
$2,182.26
|
| 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 |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,211.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| 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 |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,916.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
IP
|
$2,949.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$707.76 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,916.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.65
|
| Rate for Payer: BCBS Transplant Transplant |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.51
|
| Rate for Payer: Blue Shield of California EPN |
$94.72
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$138.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.25
|
| Rate for Payer: IEHP Medi-Cal |
$13.09
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$13.09
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
OP
|
$514.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$123.36 |
| Max. Negotiated Rate |
$817.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$186.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.24
|
| Rate for Payer: BCBS Transplant Transplant |
$308.40
|
| Rate for Payer: Blue Shield of California Commercial |
$378.82
|
| Rate for Payer: Blue Shield of California EPN |
$300.18
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$385.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: IEHP Medi-Cal |
$807.08
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$807.08
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
IP
|
$514.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$123.36 |
| Max. Negotiated Rate |
$436.90 |
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.36
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.24
|
| Rate for Payer: BCBS Transplant Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.54
|
| Rate for Payer: Blue Shield of California EPN |
$245.28
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: IEHP Medi-Cal |
$405.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$405.23
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$170.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.24
|
| Rate for Payer: BCBS Transplant Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.54
|
| Rate for Payer: Blue Shield of California EPN |
$245.28
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: IEHP Medi-Cal |
$405.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$405.23
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
IP
|
$7,460.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,790.40 |
| Max. Negotiated Rate |
$6,341.00 |
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,984.00
|
| Rate for Payer: Galaxy Health WC |
$6,341.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,476.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,975.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,842.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.40
|
| Rate for Payer: Multiplan Commercial |
$5,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,849.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,341.00
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
OP
|
$7,460.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$231.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$803.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,444.67
|
| Rate for Payer: BCBS Transplant Transplant |
$4,476.00
|
| 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 |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cigna of CA HMO |
$4,774.40
|
| Rate for Payer: Cigna of CA PPO |
$5,520.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$6,341.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,476.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,595.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| Rate for Payer: IEHP Medi-Cal |
$1,317.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,317.32
|
| Rate for Payer: IEHP Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,975.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$5,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,849.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,341.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,476.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,476.00
|
| 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 |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,261.44 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.72 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$533.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.04
|
| Rate for Payer: BCBS Transplant Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,106.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,465.06
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: IEHP Medi-Cal |
$4,122.69
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
