|
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 |
$14,109.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$25,400.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,600.00
|
| 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 |
$26,000.00
|
| 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
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
IP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
915357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,000.00 |
| Max. Negotiated Rate |
$34,000.00 |
| Rate for Payer: Multiplan Commercial |
$32,000.00
|
| Rate for Payer: Adventist Health Commercial |
$8,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$25,400.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,600.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,600.00
|
| Rate for Payer: Networks By Design Commercial |
$26,000.00
|
| 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
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
|
IP
|
$3,833.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$766.60 |
| Max. Negotiated Rate |
$3,258.05 |
| Rate for Payer: Adventist Health Commercial |
$766.60
|
| Rate for Payer: Cash Price |
$1,724.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,683.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,533.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,533.20
|
| Rate for Payer: Galaxy Health WC |
$3,258.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,299.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,433.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,261.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.92
|
| Rate for Payer: Multiplan Commercial |
$3,066.40
|
| Rate for Payer: Networks By Design Commercial |
$2,491.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,258.05
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$4,374.19 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Adventist Health Commercial |
$766.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,374.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,374.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,767.01
|
| Rate for Payer: Blue Shield of California Commercial |
$504.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,671.60
|
| Rate for Payer: Blue Shield of California Commercial |
$763.22
|
| Rate for Payer: Cash Price |
$1,724.85
|
| Rate for Payer: Cash Price |
$1,724.85
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$2,453.12
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Cigna of CA PPO |
$2,836.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$766.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,683.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Galaxy Health WC |
$3,258.05
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,299.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$399.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$399.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,433.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$3,066.40
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$2,491.45
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,258.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,299.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,299.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$927.80 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cigna of CA HMO |
$2,968.96
|
| Rate for Payer: Cigna of CA PPO |
$3,432.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,247.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$3,943.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,783.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,945.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$997.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,683.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,973.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$3,711.20
|
| Rate for Payer: Multiplan WC |
$2,457.69
|
| Rate for Payer: Networks By Design Commercial |
$3,015.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,943.15
|
| Rate for Payer: Prime Health Services WC |
$2,432.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,783.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,319.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,319.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,319.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,319.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$927.80 |
| Max. Negotiated Rate |
$3,943.15 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,247.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,855.60
|
| Rate for Payer: Galaxy Health WC |
$3,943.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,783.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,945.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,737.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Multiplan Commercial |
$3,711.20
|
| Rate for Payer: Networks By Design Commercial |
$3,015.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,943.15
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,263.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cigna of CA HMO |
$2,968.96
|
| Rate for Payer: Cigna of CA PPO |
$3,432.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,247.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$3,943.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,783.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$881.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,945.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$997.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,973.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$3,711.20
|
| Rate for Payer: Networks By Design Commercial |
$3,015.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,943.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,783.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,783.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$927.80 |
| Max. Negotiated Rate |
$3,943.15 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,247.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,855.60
|
| Rate for Payer: Galaxy Health WC |
$3,943.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,783.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,945.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,737.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Multiplan Commercial |
$3,711.20
|
| Rate for Payer: Networks By Design Commercial |
$3,015.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,943.15
|
|
|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900400026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900400026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCARE COMM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900407032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN MCARE COMM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900407032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$163.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$163.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC ELECT STIM/RECRD BRAIN INTL HR
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT 95961
|
| Hospital Charge Code |
900600401
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC ELECT STIM/RECRD BRAIN INTL HR
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT 95961
|
| Hospital Charge Code |
900600401
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$731.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,067.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,617.33
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| 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 |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC ELECT STIM/RECRD BRAIN SUB HR
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 95962
|
| Hospital Charge Code |
900600402
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC ELECT STIM/RECRD BRAIN SUB HR
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 95962
|
| Hospital Charge Code |
900600402
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$344.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.54
|
| Rate for Payer: Blue Shield of California Commercial |
$292.84
|
| Rate for Payer: Blue Shield of California Commercial |
$193.24
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA HMO |
$293.76
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$390.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$321.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$321.30
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$275.40
|
| 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 |
$390.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.54 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$113.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
