|
HC NEEDLE ELEC CRANI NERVE UNI
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 95867
|
| Hospital Charge Code |
900600252
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$325.33
|
| 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 |
$304.59
|
| Rate for Payer: Blue Shield of California Commercial |
$303.55
|
| Rate for Payer: Blue Shield of California EPN |
$200.38
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cigna of CA HMO |
$317.44
|
| Rate for Payer: Cigna of CA PPO |
$367.04
|
| 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 |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| 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 |
$396.80
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$297.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$297.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 NEEDLE ELEC CRANI NERVE UNI
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 95867
|
| Hospital Charge Code |
900600252
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$421.60 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Senior |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| Rate for Payer: Multiplan Commercial |
$396.80
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
|
|
HC NEEDLE ELEC LIMIT STUDY 1 SITE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
900600255
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.25
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$115.95
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEEDLE ELEC LIMIT STUDY 1 SITE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
900600255
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC NEEDLE ELECT CRANI NERVE BI
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 95868
|
| Hospital Charge Code |
900600253
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
|
|
HC NEEDLE ELECT CRANI NERVE BI
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 95868
|
| Hospital Charge Code |
900600253
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$487.99
|
| 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 |
$456.89
|
| Rate for Payer: Blue Shield of California Commercial |
$455.33
|
| Rate for Payer: Blue Shield of California EPN |
$300.58
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna of CA HMO |
$476.16
|
| Rate for Payer: Cigna of CA PPO |
$550.56
|
| 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 |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| 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 |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$446.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$446.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEEDLE ELEC THOR/SPINAL MUSC
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
900600254
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.12
|
| 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 |
$221.08
|
| Rate for Payer: Blue Shield of California Commercial |
$220.32
|
| Rate for Payer: Blue Shield of California EPN |
$145.44
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna of CA HMO |
$230.40
|
| Rate for Payer: Cigna of CA PPO |
$266.40
|
| 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 |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Networks By Design Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEEDLE ELEC THOR/SPINAL MUSC
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
900600254
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Senior |
$144.00
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Networks By Design Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
|
|
HC NEEDLE EMG 1 EXT W/ WO PARASP
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
900600233
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$2,329.00 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,096.00
|
| Rate for Payer: Galaxy Health WC |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,696.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.60
|
| Rate for Payer: Multiplan Commercial |
$2,192.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
|
|
HC NEEDLE EMG 1 EXT W/ WO PARASP
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
900600233
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$110.21 |
| Max. Negotiated Rate |
$2,329.00 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,797.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,682.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,106.96
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cigna of CA HMO |
$1,753.60
|
| Rate for Payer: Cigna of CA PPO |
$2,027.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$2,192.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Adventist Health Commercial |
$375.00
|
| Rate for Payer: Cash Price |
$1,031.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$750.00
|
| Rate for Payer: Galaxy Health WC |
$1,593.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,250.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$714.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,160.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: Networks By Design Commercial |
$1,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,593.75
|
|
|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Adventist Health Commercial |
$375.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,229.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,151.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.50
|
| Rate for Payer: Blue Shield of California EPN |
$757.50
|
| Rate for Payer: Cash Price |
$1,031.25
|
| Rate for Payer: Cash Price |
$1,031.25
|
| Rate for Payer: Cash Price |
$1,031.25
|
| Rate for Payer: Cigna of CA HMO |
$1,200.00
|
| Rate for Payer: Cigna of CA PPO |
$1,387.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,593.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,125.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,250.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: Networks By Design Commercial |
$1,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,593.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
OP
|
$2,882.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$187.24 |
| Max. Negotiated Rate |
$2,449.70 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,890.30
|
| 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 |
$1,769.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,763.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.33
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: Cigna of CA HMO |
$1,844.48
|
| Rate for Payer: Cigna of CA PPO |
$2,132.68
|
| 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 |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.68
|
| 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 |
$2,305.60
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,729.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
IP
|
$2,882.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$2,449.70 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.80
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,783.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.68
|
| Rate for Payer: Multiplan Commercial |
$2,305.60
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
IP
|
$2,882.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$2,449.70 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.80
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,783.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.68
|
| Rate for Payer: Multiplan Commercial |
$2,305.60
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
OP
|
$2,882.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$2,449.70 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,890.30
|
| 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 |
$1,769.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,763.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.33
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: Cash Price |
$1,585.10
|
| Rate for Payer: Cigna of CA HMO |
$1,844.48
|
| Rate for Payer: Cigna of CA PPO |
$2,132.68
|
| 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 |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.68
|
| 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 |
$2,305.60
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,729.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NEFF SET
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC NEFF SET
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$296.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.57
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$316.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$145.84
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
IP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$314.98 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Cash Price |
$203.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.93
|
| Rate for Payer: Multiplan Commercial |
$296.45
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
OP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$314.98 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.56
|
| Rate for Payer: Cash Price |
$203.81
|
| Rate for Payer: Cigna of CA HMO |
$237.16
|
| Rate for Payer: Cigna of CA PPO |
$274.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.39
|
| Rate for Payer: Multiplan Commercial |
$296.45
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Other HMO |
$185.28
|
| Rate for Payer: United Healthcare HMO Rider |
$185.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.98
|
| Rate for Payer: Vantage Medical Group Senior |
$314.98
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
IP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$103.54
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
OP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.48
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Cigna of CA HMO |
$82.84
|
| Rate for Payer: Cigna of CA PPO |
$95.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.60
|
| Rate for Payer: Multiplan Commercial |
$103.54
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.72
|
| Rate for Payer: United Healthcare All Other HMO |
$64.72
|
| Rate for Payer: United Healthcare HMO Rider |
$64.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.02
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
