|
HC NEPHROSTOMY CATH KIT
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.09
|
| Rate for Payer: United Healthcare All Other HMO |
$113.97
|
| Rate for Payer: United Healthcare HMO Rider |
$111.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.18
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
IP
|
$4,941.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$988.20 |
| Max. Negotiated Rate |
$4,199.85 |
| Rate for Payer: Adventist Health Commercial |
$988.20
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,976.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,976.40
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,882.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,058.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.84
|
| Rate for Payer: Multiplan Commercial |
$3,952.80
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
OP
|
$4,941.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$4,268.66 |
| Rate for Payer: Adventist Health Commercial |
$988.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,240.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$889.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,023.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,996.16
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cigna of CA HMO |
$3,162.24
|
| Rate for Payer: Cigna of CA PPO |
$3,656.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$3,952.80
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,964.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,964.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$729.91 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,557.56
|
| Rate for Payer: Blue Shield of California EPN |
$3,008.59
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cigna of CA HMO |
$4,766.08
|
| Rate for Payer: Cigna of CA PPO |
$5,510.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$729.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,468.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,468.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,723.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,723.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,723.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,723.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,489.40 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,978.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,978.80
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$825.49 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: Cigna of CA HMO |
$4,766.08
|
| Rate for Payer: Cigna of CA PPO |
$5,510.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,468.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,723.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,723.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,723.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,723.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,489.40 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Cash Price |
$3,351.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,978.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,978.80
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.20 |
| Max. Negotiated Rate |
$1,067.60 |
| Rate for Payer: Adventist Health Commercial |
$251.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.40
|
| Rate for Payer: EPIC Health Plan Senior |
$502.40
|
| Rate for Payer: Galaxy Health WC |
$1,067.60
|
| Rate for Payer: Global Benefits Group Commercial |
$753.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.44
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Networks By Design Commercial |
$816.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,067.60
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.20 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$251.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,067.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$690.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$942.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna of CA HMO |
$803.84
|
| Rate for Payer: Cigna of CA PPO |
$929.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,067.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,067.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.40
|
| Rate for Payer: EPIC Health Plan Senior |
$502.40
|
| Rate for Payer: Galaxy Health WC |
$1,067.60
|
| Rate for Payer: Global Benefits Group Commercial |
$753.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$879.20
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Networks By Design Commercial |
$816.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,067.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$628.00
|
| Rate for Payer: United Healthcare HMO Rider |
$628.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$628.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,067.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,067.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,067.60
|
|
|
HC NERVE TEASING
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.71
|
| Rate for Payer: Blue Shield of California Commercial |
$228.80
|
| Rate for Payer: Blue Shield of California EPN |
$151.16
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO |
$218.88
|
| Rate for Payer: Cigna of CA PPO |
$253.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$303.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: Networks By Design Commercial |
$222.30
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC NERVE TEASING
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$204.60 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Adventist Health Commercial |
$204.60
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.20
|
| Rate for Payer: EPIC Health Plan Senior |
$409.20
|
| Rate for Payer: Galaxy Health WC |
$869.55
|
| Rate for Payer: Global Benefits Group Commercial |
$613.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$633.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.52
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: Networks By Design Commercial |
$664.95
|
| Rate for Payer: Prime Health Services Commercial |
$869.55
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Adventist Health Commercial |
$419.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$670.99
|
| 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 |
$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: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cigna of CA HMO |
$654.72
|
| Rate for Payer: Cigna of CA PPO |
$757.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$869.55
|
| Rate for Payer: Global Benefits Group Commercial |
$613.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: Networks By Design Commercial |
$664.95
|
| Rate for Payer: Prime Health Services Commercial |
$869.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$613.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| 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: 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 NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Adventist Health Commercial |
$419.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$670.99
|
| 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 |
$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: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cigna of CA HMO |
$654.72
|
| Rate for Payer: Cigna of CA PPO |
$757.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$869.55
|
| Rate for Payer: Global Benefits Group Commercial |
$613.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: Networks By Design Commercial |
$664.95
|
| Rate for Payer: Prime Health Services Commercial |
$869.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$613.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| 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: 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 NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$204.60 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Adventist Health Commercial |
$204.60
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.20
|
| Rate for Payer: EPIC Health Plan Senior |
$409.20
|
| Rate for Payer: Galaxy Health WC |
$869.55
|
| Rate for Payer: Global Benefits Group Commercial |
$613.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$633.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.52
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: Networks By Design Commercial |
$664.95
|
| Rate for Payer: Prime Health Services Commercial |
$869.55
|
|
|
HC NEUROBEHAV STATUS W/RPT EA ADD HR
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
905601805
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$431.80 |
| Rate for Payer: Adventist Health Commercial |
$101.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$203.20
|
| Rate for Payer: Galaxy Health WC |
$431.80
|
| Rate for Payer: Global Benefits Group Commercial |
$304.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.92
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Networks By Design Commercial |
$330.20
|
| Rate for Payer: Prime Health Services Commercial |
$431.80
|
|
|
HC NEUROBEHAV STATUS W/RPT EA ADD HR
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
905601805
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$117.89 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$208.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$431.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.00
|
| 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: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna of CA HMO |
$325.12
|
| Rate for Payer: Cigna of CA PPO |
$375.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$431.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$431.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$203.20
|
| Rate for Payer: Galaxy Health WC |
$431.80
|
| Rate for Payer: Global Benefits Group Commercial |
$304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$355.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$355.60
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Networks By Design Commercial |
$330.20
|
| Rate for Payer: Prime Health Services Commercial |
$431.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$431.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.80
|
| Rate for Payer: Vantage Medical Group Senior |
$431.80
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.75
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69.00
|
| Rate for Payer: United Healthcare HMO Rider |
$69.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$198.27 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$933.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cigna of CA HMO |
$2,986.24
|
| Rate for Payer: Cigna of CA PPO |
$3,452.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,966.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,799.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,112.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,119.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$3,732.80
|
| Rate for Payer: Networks By Design Commercial |
$3,032.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,966.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,799.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$8,753.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,750.60 |
| Max. Negotiated Rate |
$7,440.05 |
| Rate for Payer: Adventist Health Commercial |
$1,750.60
|
| Rate for Payer: Cash Price |
$3,938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,501.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,501.20
|
| Rate for Payer: Galaxy Health WC |
$7,440.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,251.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,838.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,334.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,418.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.72
|
| Rate for Payer: Multiplan Commercial |
$7,002.40
|
| Rate for Payer: Networks By Design Commercial |
$5,689.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,440.05
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| 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 NEUROMUSCULAR JUNCTION TEST
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$2,039.00 |
| 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 |
$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 |
$234.59
|
| Rate for Payer: Blue Shield of California Commercial |
$233.78
|
| Rate for Payer: Blue Shield of California EPN |
$154.33
|
| Rate for Payer: Cash Price |
$171.90
|
| 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 |
$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 |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.68
|
| 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 |
$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 |
$2,039.00
|
| 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 NEUROSTIM INSERT/REPL GEN
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,762.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,767.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cigna of CA HMO |
$80,014.72
|
| Rate for Payer: Cigna of CA PPO |
$92,517.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$106,269.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106,269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,516.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,516.10
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75,013.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Senior |
$106,269.55
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,004.60 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
|
