|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
OP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
915357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,369.60 |
| Max. Negotiated Rate |
$22,559.00 |
| Rate for Payer: Adventist Health Commercial |
$10,881.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,597.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,905.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,371.97
|
| Rate for Payer: Blue Shield of California Commercial |
$19,586.52
|
| Rate for Payer: Blue Shield of California EPN |
$12,898.44
|
| Rate for Payer: Cash Price |
$14,597.00
|
| Rate for Payer: Cash Price |
$14,597.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,559.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,559.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,379.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,215.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,369.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,578.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,578.00
|
| Rate for Payer: Multiplan Commercial |
$21,232.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,559.00
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
IP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
915357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,308.00 |
| Max. Negotiated Rate |
$22,559.00 |
| Rate for Payer: Adventist Health Commercial |
$5,308.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14,597.00
|
| Rate for Payer: Cash Price |
$14,597.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,111.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,369.60
|
| Rate for Payer: Multiplan Commercial |
$21,232.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
915357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,084.56 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$6,977.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,857.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,560.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,271.23
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,466.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,887.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,913.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,913.30
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,084.56 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$6,977.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,857.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,560.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,271.23
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,466.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,887.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,913.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,913.30
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
915357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$3,403.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$3,403.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cash Price |
$9,360.45
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27,359.04 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$46,738.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85,497.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,026.48
|
| Rate for Payer: Blue Shield of California Commercial |
$84,129.05
|
| Rate for Payer: Blue Shield of California EPN |
$55,402.06
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$96,896.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,400.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,989.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,797.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,797.20
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
915357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27,359.04 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$46,738.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85,497.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,026.48
|
| Rate for Payer: Blue Shield of California Commercial |
$84,129.05
|
| Rate for Payer: Blue Shield of California EPN |
$55,402.06
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$96,896.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,400.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,989.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,797.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,797.20
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,501.00 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$22,799.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,432.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
915357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,501.00 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$22,799.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cash Price |
$62,697.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,432.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$400.60 |
| Max. Negotiated Rate |
$1,702.55 |
| Rate for Payer: Adventist Health Commercial |
$400.60
|
| Rate for Payer: Cash Price |
$1,101.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: EPIC Health Plan Senior |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,239.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.72
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$373.77 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$400.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,313.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,702.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,101.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,502.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,230.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,225.84
|
| Rate for Payer: Blue Shield of California EPN |
$809.21
|
| Rate for Payer: Cash Price |
$1,101.65
|
| Rate for Payer: Cash Price |
$1,101.65
|
| Rate for Payer: Cash Price |
$1,101.65
|
| Rate for Payer: Cigna of CA HMO |
$1,281.92
|
| Rate for Payer: Cigna of CA PPO |
$1,482.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,702.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,702.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,702.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: EPIC Health Plan Senior |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$373.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,239.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,402.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,402.10
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,201.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,201.80
|
| 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 |
$1,702.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,702.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,702.55
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
|
IP
|
$2,773.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$554.60 |
| Max. Negotiated Rate |
$2,357.05 |
| Rate for Payer: Adventist Health Commercial |
$554.60
|
| Rate for Payer: Cash Price |
$1,525.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.20
|
| Rate for Payer: Galaxy Health WC |
$2,357.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,849.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,056.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,716.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.52
|
| Rate for Payer: Multiplan Commercial |
$2,218.40
|
| Rate for Payer: Networks By Design Commercial |
$1,802.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,357.05
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
|
OP
|
$2,773.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$157.99 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$554.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$1,702.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,525.15
|
| Rate for Payer: Cash Price |
$1,525.15
|
| Rate for Payer: Cash Price |
$1,525.15
|
| Rate for Payer: Cigna of CA HMO |
$1,774.72
|
| Rate for Payer: Cigna of CA PPO |
$2,052.02
|
| 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 |
$2,357.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,849.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.52
|
| 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 |
$2,218.40
|
| Rate for Payer: Networks By Design Commercial |
$1,802.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,357.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 ELECTROLYTE PANEL
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.29
|
| Rate for Payer: Blue Shield of California Commercial |
$153.87
|
| Rate for Payer: Blue Shield of California EPN |
$101.66
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.68
|
| Rate for Payer: Blue Shield of California Commercial |
$263.77
|
| Rate for Payer: Blue Shield of California EPN |
$174.12
|
| Rate for Payer: Cash Price |
$237.05
|
| Rate for Payer: Cash Price |
$237.05
|
| Rate for Payer: Cash Price |
$237.05
|
| Rate for Payer: Cigna of CA HMO |
$275.84
|
| Rate for Payer: Cigna of CA PPO |
$318.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$366.35 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$237.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Senior |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.44
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.29
|
| 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 |
$211.86
|
| Rate for Payer: Blue Shield of California Commercial |
$211.14
|
| Rate for Payer: Blue Shield of California EPN |
$139.38
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cash Price |
$189.75
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| 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 |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| 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 |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| 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 ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$123.06 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.22
|
| 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 |
$386.88
|
| Rate for Payer: Blue Shield of California Commercial |
$385.56
|
| Rate for Payer: Blue Shield of California EPN |
$254.52
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$466.20
|
| 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 |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| 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 |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| 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 ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$389.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
OP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
915357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,600.00 |
| Max. Negotiated Rate |
$34,000.00 |
| Rate for Payer: Adventist Health Commercial |
$16,400.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22,000.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29,520.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,440.00
|
| Rate for Payer: Cash Price |
$22,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,000.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,000.00
|
| Rate for Payer: Multiplan Commercial |
$32,000.00
|
| Rate for Payer: Networks By Design Commercial |
$20,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34,000.00
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
OP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
905357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,600.00 |
| Max. Negotiated Rate |
$34,000.00 |
| Rate for Payer: Adventist Health Commercial |
$16,400.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22,000.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29,520.00
|
| Rate for Payer: Blue Shield of California EPN |
$19,440.00
|
| Rate for Payer: Cash Price |
$22,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,000.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,000.00
|
| Rate for Payer: Multiplan Commercial |
$32,000.00
|
| Rate for Payer: Networks By Design Commercial |
$20,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34,000.00
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
IP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
905357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,000.00 |
| Max. Negotiated Rate |
$34,000.00 |
| Rate for Payer: Adventist Health Commercial |
$8,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22,000.00
|
| Rate for Payer: Cash Price |
$22,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,240.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,600.00
|
| Rate for Payer: Multiplan Commercial |
$32,000.00
|
| Rate for Payer: Networks By Design Commercial |
$20,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
|
