|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
905356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
|
|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
OP
|
$4,696.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
915356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,127.04 |
| Max. Negotiated Rate |
$3,991.60 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| Rate for Payer: Adventist Health Commercial |
$1,925.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,582.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,522.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,719.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3,465.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,282.26
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Cigna of CA HMO |
$3,287.20
|
| Rate for Payer: Cigna of CA PPO |
$3,287.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,991.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,991.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,878.40
|
| Rate for Payer: Galaxy Health WC |
$3,991.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,817.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,354.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,132.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,906.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,287.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,287.20
|
| Rate for Payer: Multiplan Commercial |
$3,756.80
|
| Rate for Payer: Networks By Design Commercial |
$2,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,991.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,817.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,817.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,762.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,715.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,678.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,537.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,991.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,991.60
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
905356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,332.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.64
|
| Rate for Payer: Multiplan Commercial |
$5,328.80
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
915356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,332.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.64
|
| Rate for Payer: Multiplan Commercial |
$5,328.80
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
915356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,598.64 |
| Max. Negotiated Rate |
$5,661.85 |
| Rate for Payer: Adventist Health Commercial |
$2,731.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,858.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,237.25
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,918.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,662.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,662.70
|
| Rate for Payer: Multiplan Commercial |
$5,328.80
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.85
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
905356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,598.64 |
| Max. Negotiated Rate |
$5,661.85 |
| Rate for Payer: Adventist Health Commercial |
$2,731.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,858.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,237.25
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cash Price |
$3,663.55
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,918.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,662.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,662.70
|
| Rate for Payer: Multiplan Commercial |
$5,328.80
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.85
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$126.97 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$437.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,433.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,341.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.22
|
| Rate for Payer: Blue Shield of California EPN |
$882.74
|
| Rate for Payer: Cash Price |
$1,201.75
|
| Rate for Payer: Cash Price |
$1,201.75
|
| Rate for Payer: Cash Price |
$1,201.75
|
| Rate for Payer: Cigna of CA HMO |
$1,398.40
|
| Rate for Payer: Cigna of CA PPO |
$1,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,748.00
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,311.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,311.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$437.00 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Adventist Health Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$1,201.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Senior |
$874.00
|
| Rate for Payer: Galaxy Health WC |
$1,857.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,311.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,457.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$832.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,352.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.40
|
| Rate for Payer: Multiplan Commercial |
$1,748.00
|
| Rate for Payer: Networks By Design Commercial |
$1,420.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,857.25
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
OP
|
$3,245.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$109.22 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Adventist Health Commercial |
$649.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,128.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,985.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,310.98
|
| Rate for Payer: Cash Price |
$1,784.75
|
| Rate for Payer: Cash Price |
$1,784.75
|
| Rate for Payer: Cash Price |
$1,784.75
|
| Rate for Payer: Cigna of CA HMO |
$2,076.80
|
| Rate for Payer: Cigna of CA PPO |
$2,401.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,758.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,596.00
|
| Rate for Payer: Networks By Design Commercial |
$2,109.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,947.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,947.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
IP
|
$3,245.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$649.00 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Adventist Health Commercial |
$649.00
|
| Rate for Payer: Cash Price |
$1,784.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,298.00
|
| Rate for Payer: Galaxy Health WC |
$2,758.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.80
|
| Rate for Payer: Multiplan Commercial |
$2,596.00
|
| Rate for Payer: Networks By Design Commercial |
$2,109.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.25
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.81
|
| Rate for Payer: Blue Shield of California Commercial |
$564.88
|
| Rate for Payer: Blue Shield of California EPN |
$372.89
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$409.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
OP
|
$5,004.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$4,253.40 |
| Rate for Payer: Adventist Health Commercial |
$1,000.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,282.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,253.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,752.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,072.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,062.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,021.62
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: Cigna of CA HMO |
$3,202.56
|
| Rate for Payer: Cigna of CA PPO |
$3,702.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,253.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,253.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,001.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,001.60
|
| Rate for Payer: Galaxy Health WC |
$4,253.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,002.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,337.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,097.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,502.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,502.80
|
| Rate for Payer: Multiplan Commercial |
$4,003.20
|
| Rate for Payer: Networks By Design Commercial |
$3,252.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,253.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,002.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,002.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,253.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,253.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,253.40
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
IP
|
$5,004.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,000.80 |
| Max. Negotiated Rate |
$4,253.40 |
| Rate for Payer: Adventist Health Commercial |
$1,000.80
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,001.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,001.60
|
| Rate for Payer: Galaxy Health WC |
$4,253.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,002.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,337.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,906.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,097.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.96
|
| Rate for Payer: Multiplan Commercial |
$4,003.20
|
| Rate for Payer: Networks By Design Commercial |
$3,252.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,253.40
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$1,916.75 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$902.00
|
| Rate for Payer: EPIC Health Plan Senior |
$902.00
|
| Rate for Payer: Galaxy Health WC |
$1,916.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,504.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,395.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.20
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: Networks By Design Commercial |
$1,465.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,916.75
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cigna of CA HMO |
$1,443.20
|
| Rate for Payer: Cigna of CA PPO |
$1,668.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,916.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,504.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: Networks By Design Commercial |
$1,465.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,916.75
|
| Rate for Payer: Prime Health Services WC |
$623.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,353.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,127.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,127.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,127.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG FOR ECS
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$247.60 |
| Max. Negotiated Rate |
$1,052.30 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Senior |
$495.20
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$766.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
|
|
HC EEG FOR ECS
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$812.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$760.26
|
| Rate for Payer: Blue Shield of California Commercial |
$757.66
|
| Rate for Payer: Blue Shield of California EPN |
$500.15
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: Cigna of CA HMO |
$792.32
|
| Rate for Payer: Cigna of CA PPO |
$916.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$742.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
OP
|
$3,729.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$187.05 |
| Max. Negotiated Rate |
$3,169.65 |
| Rate for Payer: Adventist Health Commercial |
$745.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,445.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,289.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,282.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,506.52
|
| Rate for Payer: Cash Price |
$2,050.95
|
| Rate for Payer: Cash Price |
$2,050.95
|
| Rate for Payer: Cash Price |
$2,050.95
|
| Rate for Payer: Cigna of CA HMO |
$2,386.56
|
| Rate for Payer: Cigna of CA PPO |
$2,759.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$3,169.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,237.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,487.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,983.20
|
| Rate for Payer: Networks By Design Commercial |
$2,423.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,169.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,237.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,237.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
IP
|
$3,729.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$745.80 |
| Max. Negotiated Rate |
$3,169.65 |
| Rate for Payer: Adventist Health Commercial |
$745.80
|
| Rate for Payer: Cash Price |
$2,050.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,491.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,491.60
|
| Rate for Payer: Galaxy Health WC |
$3,169.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,237.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,487.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,420.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,308.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.96
|
| Rate for Payer: Multiplan Commercial |
$2,983.20
|
| Rate for Payer: Networks By Design Commercial |
$2,423.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,169.65
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$642.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$601.82
|
| Rate for Payer: Blue Shield of California Commercial |
$599.76
|
| Rate for Payer: Blue Shield of California EPN |
$395.92
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
HC EEG SEIZ MONT CABLE/RADIO 16CH
|
Facility
|
OP
|
$8,203.00
|
|
|
Service Code
|
CPT 95956
|
| Hospital Charge Code |
900600265
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$6,972.55 |
| Rate for Payer: Adventist Health Commercial |
$1,640.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,380.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,972.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,511.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,037.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5,020.24
|
| Rate for Payer: Blue Shield of California EPN |
$3,314.01
|
| Rate for Payer: Cash Price |
$4,511.65
|
| Rate for Payer: Cash Price |
$4,511.65
|
| Rate for Payer: Cigna of CA HMO |
$5,249.92
|
| Rate for Payer: Cigna of CA PPO |
$6,070.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,972.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,972.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,972.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,281.20
|
| Rate for Payer: Galaxy Health WC |
$6,972.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,921.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,471.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,125.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,077.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,968.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,742.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,742.10
|
| Rate for Payer: Multiplan Commercial |
$6,562.40
|
| Rate for Payer: Networks By Design Commercial |
$5,331.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,972.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,921.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,921.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,972.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,972.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,972.55
|
|
|
HC EEG SEIZ MONT CABLE/RADIO 16CH
|
Facility
|
IP
|
$8,203.00
|
|
|
Service Code
|
CPT 95956
|
| Hospital Charge Code |
900600265
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,640.60 |
| Max. Negotiated Rate |
$6,972.55 |
| Rate for Payer: Adventist Health Commercial |
$1,640.60
|
| Rate for Payer: Cash Price |
$4,511.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,281.20
|
| Rate for Payer: Galaxy Health WC |
$6,972.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,921.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,471.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,125.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,077.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$6,562.40
|
| Rate for Payer: Networks By Design Commercial |
$5,331.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,972.55
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$109.22 |
| Max. Negotiated Rate |
$2,620.55 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,022.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,893.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,886.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,245.53
|
| Rate for Payer: Cash Price |
$1,695.65
|
| Rate for Payer: Cash Price |
$1,695.65
|
| Rate for Payer: Cash Price |
$1,695.65
|
| Rate for Payer: Cigna of CA HMO |
$1,973.12
|
| Rate for Payer: Cigna of CA PPO |
$2,281.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,056.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,849.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,849.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
