|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,346.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,250.80
|
| 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 |
$1,378.00
|
| 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: 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 |
$2,842.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,611.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,380.87
|
| Rate for Payer: Cash Price |
$2,113.20
|
| Rate for Payer: Cash Price |
$2,113.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,981.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,531.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,770.64
|
| 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 FLEX HING TRICEPS
|
Facility
|
IP
|
$4,696.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
915356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$939.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$939.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,113.20
|
| Rate for Payer: Cash Price |
$2,113.20
|
| Rate for Payer: Cigna of CA HMO |
$3,287.20
|
| Rate for Payer: Cigna of CA PPO |
$3,287.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,981.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,770.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.04
|
| Rate for Payer: Multiplan Commercial |
$3,756.80
|
| Rate for Payer: Networks By Design Commercial |
$3,052.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,991.60
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,229.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.99
|
| 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 |
$4,329.65
|
| 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 |
$4,031.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5,122.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,377.13
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,918.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,229.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.99
|
| 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 |
$4,031.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5,122.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,377.13
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,918.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,229.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.99
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,229.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,929.99
|
| 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 |
$4,329.65
|
| 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 EDUCATION TRAINING SELF MGMT 2-4 PATIENTS
|
Facility
|
OP
|
$12.66
|
|
|
Service Code
|
CPT 98961 U2
|
| Hospital Charge Code |
950098961
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$5.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.12
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO |
$8.10
|
| Rate for Payer: Cigna of CA PPO |
$9.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.06
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$10.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$10.13
|
| Rate for Payer: Networks By Design Commercial |
$8.23
|
| Rate for Payer: Prime Health Services Commercial |
$10.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.76
|
| Rate for Payer: Vantage Medical Group Senior |
$10.76
|
|
|
HC EDUCATION TRAINING SELF MGMT 2-4 PATIENTS
|
Facility
|
IP
|
$12.66
|
|
|
Service Code
|
CPT 98961 U2
|
| Hospital Charge Code |
950098961
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.06
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$10.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$10.13
|
| Rate for Payer: Networks By Design Commercial |
$8.23
|
| Rate for Payer: Prime Health Services Commercial |
$10.76
|
|
|
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 |
$983.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,529.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,387.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,289.15
|
| 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/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 |
$1,746.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,402.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,394.03
|
| Rate for Payer: Blue Shield of California Commercial |
$919.88
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| Rate for Payer: Cash Price |
$983.25
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,529.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| 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/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,387.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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 |
$1,997.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,082.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,070.31
|
| Rate for Payer: Cash Price |
$1,460.25
|
| Rate for Payer: Cash Price |
$1,460.25
|
| Rate for Payer: Cash Price |
$1,460.25
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,271.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| 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/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,060.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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 |
$1,460.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,271.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,060.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.55
|
| 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
|
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 |
$1,606.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.29
|
| Rate for Payer: Blue Shield of California Commercial |
$388.58
|
| Rate for Payer: Blue Shield of California Commercial |
$588.87
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$646.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$409.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$586.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$462.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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 |
$415.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$646.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$586.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$544.57
|
| 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 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 |
$866.45
|
| 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 |
$3,211.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3,192.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,106.68
|
| Rate for Payer: Cash Price |
$2,251.80
|
| Rate for Payer: Cash Price |
$2,251.80
|
| Rate for Payer: Cash Price |
$2,251.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,502.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,177.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,952.36
|
| 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 |
$2,251.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,502.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,177.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,952.36
|
| 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 |
$1,014.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,578.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,431.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.45
|
| 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 |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,578.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| 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/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,431.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$298.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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: Cash Price |
$557.10
|
| Rate for Payer: Cigna of CA HMO |
$792.32
|
| Rate for Payer: Cigna of CA PPO |
$916.12
|
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$427.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$794.42
|
| Rate for Payer: Blue Shield of California Commercial |
$521.20
|
| Rate for Payer: Blue Shield of California Commercial |
$789.84
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$866.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| 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/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$786.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| 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
|
| 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 |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
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 |
$557.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$866.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$786.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$730.42
|
| 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 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 |
$1,678.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,610.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,367.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,200.11
|
| 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 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 |
$1,979.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,392.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,569.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.10
|
| Rate for Payer: Cash Price |
$1,678.05
|
| Rate for Payer: Cash Price |
$1,678.05
|
| Rate for Payer: Cash Price |
$1,678.05
|
| 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 |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,610.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| 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/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,367.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| 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 |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$686.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$622.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$578.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
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 |
$1,445.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$628.87
|
| Rate for Payer: Blue Shield of California Commercial |
$412.58
|
| Rate for Payer: Blue Shield of California Commercial |
$625.24
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| 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 |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$686.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$622.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| 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 |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
