|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$324.70 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.68
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$324.70 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$250.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.05
|
| Rate for Payer: Blue Shield of California Commercial |
$255.56
|
| Rate for Payer: Blue Shield of California EPN |
$168.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna of CA HMO |
$244.48
|
| Rate for Payer: Cigna of CA PPO |
$282.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$324.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.40
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.70
|
| Rate for Payer: Vantage Medical Group Senior |
$324.70
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$486.00
|
| Rate for Payer: United Healthcare All Other HMO |
$486.00
|
| Rate for Payer: United Healthcare HMO Rider |
$486.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.73
|
| Rate for Payer: Blue Shield of California Commercial |
$127.30
|
| Rate for Payer: Blue Shield of California EPN |
$84.03
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC MOTOR & SENS 11-12 NRV CNDJ TEST
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
900600329
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$926.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.00
|
| Rate for Payer: EPIC Health Plan Senior |
$436.00
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.60
|
| Rate for Payer: Multiplan Commercial |
$872.00
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
|
|
HC MOTOR & SENS 11-12 NRV CNDJ TEST
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
900600329
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$1,105.66 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$714.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$669.37
|
| Rate for Payer: Blue Shield of California Commercial |
$667.08
|
| Rate for Payer: Blue Shield of California EPN |
$440.36
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna of CA HMO |
$697.60
|
| Rate for Payer: Cigna of CA PPO |
$806.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$926.50
|
| Rate for Payer: Global Benefits Group Commercial |
$654.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$727.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$872.00
|
| Rate for Payer: Networks By Design Commercial |
$708.50
|
| Rate for Payer: Prime Health Services Commercial |
$926.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$654.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$654.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC MOTOR & SENS 1-2 NRV CNDJ TEST
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
900600324
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC MOTOR & SENS 1-2 NRV CNDJ TEST
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
900600324
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.61
|
| Rate for Payer: Blue Shield of California Commercial |
$148.10
|
| Rate for Payer: Blue Shield of California EPN |
$97.77
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MOTOR & SENS 13 NRV CNDJ TEST
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
900600330
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$1,105.66 |
| Rate for Payer: Adventist Health Commercial |
$229.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$703.14
|
| Rate for Payer: Blue Shield of California Commercial |
$700.74
|
| Rate for Payer: Blue Shield of California EPN |
$462.58
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: Cigna of CA HMO |
$732.80
|
| Rate for Payer: Cigna of CA PPO |
$847.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$973.25
|
| Rate for Payer: Global Benefits Group Commercial |
$687.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$442.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$763.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$916.00
|
| Rate for Payer: Networks By Design Commercial |
$744.25
|
| Rate for Payer: Prime Health Services Commercial |
$973.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$687.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$687.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC MOTOR & SENS 13 NRV CNDJ TEST
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
900600330
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$973.25 |
| Rate for Payer: Adventist Health Commercial |
$229.00
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$458.00
|
| Rate for Payer: Galaxy Health WC |
$973.25
|
| Rate for Payer: Global Benefits Group Commercial |
$687.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$763.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$436.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$708.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.80
|
| Rate for Payer: Multiplan Commercial |
$916.00
|
| Rate for Payer: Networks By Design Commercial |
$744.25
|
| Rate for Payer: Prime Health Services Commercial |
$973.25
|
|
|
HC MOTOR & SENS 3-4 NRV CNDJ TEST
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
900600325
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.92
|
| Rate for Payer: Blue Shield of California Commercial |
$369.65
|
| Rate for Payer: Blue Shield of California EPN |
$244.02
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO |
$386.56
|
| Rate for Payer: Cigna of CA PPO |
$446.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$513.40
|
| Rate for Payer: Global Benefits Group Commercial |
$362.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$483.20
|
| Rate for Payer: Networks By Design Commercial |
$392.60
|
| Rate for Payer: Prime Health Services Commercial |
$513.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC MOTOR & SENS 3-4 NRV CNDJ TEST
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
900600325
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$513.40 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.60
|
| Rate for Payer: EPIC Health Plan Senior |
$241.60
|
| Rate for Payer: Galaxy Health WC |
$513.40
|
| Rate for Payer: Global Benefits Group Commercial |
$362.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.96
|
| Rate for Payer: Multiplan Commercial |
$483.20
|
| Rate for Payer: Networks By Design Commercial |
$392.60
|
| Rate for Payer: Prime Health Services Commercial |
$513.40
|
|
|
HC MOTOR & SENS 5-6 NRV CNDJ TEST
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
900600326
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Senior |
$213.20
|
| Rate for Payer: Galaxy Health WC |
$453.05
|
| Rate for Payer: Global Benefits Group Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$355.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.92
|
| Rate for Payer: Multiplan Commercial |
$426.40
|
| Rate for Payer: Networks By Design Commercial |
$346.45
|
| Rate for Payer: Prime Health Services Commercial |
$453.05
|
|
|
HC MOTOR & SENS 5-6 NRV CNDJ TEST
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
900600326
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.32
|
| Rate for Payer: Blue Shield of California Commercial |
$326.20
|
| Rate for Payer: Blue Shield of California EPN |
$215.33
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cigna of CA HMO |
$341.12
|
| Rate for Payer: Cigna of CA PPO |
$394.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$453.05
|
| Rate for Payer: Global Benefits Group Commercial |
$319.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$355.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$426.40
|
| Rate for Payer: Networks By Design Commercial |
$346.45
|
| Rate for Payer: Prime Health Services Commercial |
$453.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC MOTOR & SENS 7-8 NRV CNDJ TEST
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
900600327
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$590.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.96
|
| Rate for Payer: Multiplan Commercial |
$763.20
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
|
|
HC MOTOR & SENS 7-8 NRV CNDJ TEST
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
900600327
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$625.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.85
|
| Rate for Payer: Blue Shield of California Commercial |
$583.85
|
| Rate for Payer: Blue Shield of California EPN |
$385.42
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna of CA HMO |
$610.56
|
| Rate for Payer: Cigna of CA PPO |
$705.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$763.20
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$572.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$572.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC MOTOR & SENS 9-10 NRV CNDJ TEST
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
900600328
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$207.60 |
| Max. Negotiated Rate |
$1,105.66 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$680.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.44
|
| Rate for Payer: Blue Shield of California Commercial |
$635.26
|
| Rate for Payer: Blue Shield of California EPN |
$419.35
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna of CA HMO |
$664.32
|
| Rate for Payer: Cigna of CA PPO |
$768.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$882.30
|
| Rate for Payer: Global Benefits Group Commercial |
$622.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$326.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$692.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$830.40
|
| Rate for Payer: Networks By Design Commercial |
$674.70
|
| Rate for Payer: Prime Health Services Commercial |
$882.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$622.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$622.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC MOTOR & SENS 9-10 NRV CNDJ TEST
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
900600328
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$207.60 |
| Max. Negotiated Rate |
$882.30 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.20
|
| Rate for Payer: EPIC Health Plan Senior |
$415.20
|
| Rate for Payer: Galaxy Health WC |
$882.30
|
| Rate for Payer: Global Benefits Group Commercial |
$622.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$692.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$642.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.12
|
| Rate for Payer: Multiplan Commercial |
$830.40
|
| Rate for Payer: Networks By Design Commercial |
$674.70
|
| Rate for Payer: Prime Health Services Commercial |
$882.30
|
|
|
HC MOTOR SPEECH CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8999
|
| Hospital Charge Code |
900018121
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8999
|
| Hospital Charge Code |
900018121
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MOTOR SPEECH CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8999
|
| Hospital Charge Code |
900018221
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
