|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,954.80 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,737.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,954.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,379.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,281.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.40
|
| Rate for Payer: Multiplan Commercial |
$1,629.00
|
| Rate for Payer: Networks By Design Commercial |
$1,411.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
IP
|
$6,770.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,354.00 |
| Max. Negotiated Rate |
$6,093.00 |
| Rate for Payer: Adventist Health Commercial |
$1,354.00
|
| Rate for Payer: Cash Price |
$3,046.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,416.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,739.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,708.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,708.00
|
| Rate for Payer: Galaxy Health WC |
$5,754.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,062.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,093.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,298.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,994.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.00
|
| Rate for Payer: Multiplan Commercial |
$5,077.50
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,754.50
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
OP
|
$6,770.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$6,093.00 |
| Rate for Payer: Adventist Health Commercial |
$1,354.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,754.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,723.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,077.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,938.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,265.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,687.69
|
| Rate for Payer: Cash Price |
$3,046.50
|
| Rate for Payer: Cash Price |
$3,046.50
|
| Rate for Payer: Cash Price |
$3,046.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,416.00
|
| Rate for Payer: Cigna of CA HMO |
$4,332.80
|
| Rate for Payer: Cigna of CA PPO |
$5,009.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,754.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,754.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,754.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,739.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,708.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,708.00
|
| Rate for Payer: Galaxy Health WC |
$5,754.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,062.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,093.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,298.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,994.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,739.00
|
| Rate for Payer: Multiplan Commercial |
$5,077.50
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,754.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,708.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,062.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,062.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,754.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,754.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,754.50
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$3,051.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$2,745.90 |
| Rate for Payer: Adventist Health Commercial |
$610.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$630.41
|
| Rate for Payer: Cash Price |
$1,372.95
|
| Rate for Payer: Cash Price |
$1,372.95
|
| Rate for Payer: Cash Price |
$1,372.95
|
| Rate for Payer: Cash Price |
$1,372.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,440.80
|
| Rate for Payer: Cigna of CA HMO |
$1,952.64
|
| Rate for Payer: Cigna of CA PPO |
$2,257.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,135.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$2,593.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,830.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,745.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,937.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$298.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$2,288.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: Networks By Design Commercial |
$1,983.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Preferred Health Network WC |
$643.28
|
| Rate for Payer: Prime Health Services Commercial |
$2,593.35
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Prime Health Services WC |
$623.98
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,830.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,525.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,525.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,525.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$3,051.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$610.20 |
| Max. Negotiated Rate |
$2,745.90 |
| Rate for Payer: Adventist Health Commercial |
$610.20
|
| Rate for Payer: Cash Price |
$1,372.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,440.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,135.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,220.40
|
| Rate for Payer: Galaxy Health WC |
$2,593.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,830.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,745.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,937.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.20
|
| Rate for Payer: Multiplan Commercial |
$2,288.25
|
| Rate for Payer: Networks By Design Commercial |
$1,983.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,593.35
|
|
|
HC EEG FOR ECS
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$2,879.75 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$973.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,054.62
|
| Rate for Payer: Blue Shield of California EPN |
$664.58
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,339.20
|
| Rate for Payer: Cigna of CA HMO |
$1,071.36
|
| Rate for Payer: Cigna of CA PPO |
$1,238.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,506.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,062.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,255.50
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,004.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,004.40
|
| 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 |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC EEG FOR ECS
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$1,506.60 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,339.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$669.60
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,506.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,062.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$987.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Multiplan Commercial |
$1,255.50
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,009.00 |
| Max. Negotiated Rate |
$4,540.50 |
| Rate for Payer: Adventist Health Commercial |
$1,009.00
|
| Rate for Payer: Cash Price |
$2,270.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,036.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,531.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,018.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,018.00
|
| Rate for Payer: Galaxy Health WC |
$4,288.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,027.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,540.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,203.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,976.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.00
|
| Rate for Payer: Multiplan Commercial |
$3,783.75
|
| Rate for Payer: Networks By Design Commercial |
$3,279.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,288.25
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$191.50 |
| Max. Negotiated Rate |
$4,540.50 |
| Rate for Payer: Adventist Health Commercial |
$1,009.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,746.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,934.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3,178.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,002.87
|
| Rate for Payer: Cash Price |
$2,270.25
|
| Rate for Payer: Cash Price |
$2,270.25
|
| Rate for Payer: Cash Price |
$2,270.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,036.00
|
| Rate for Payer: Cigna of CA HMO |
$3,228.80
|
| Rate for Payer: Cigna of CA PPO |
$3,733.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,531.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$4,288.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,027.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,540.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,203.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$3,783.75
|
| Rate for Payer: Networks By Design Commercial |
$3,279.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$4,288.25
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,027.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,027.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EEG MONITOR 16+ CHAN, EA 24 HR
|
Facility
|
OP
|
$10,204.00
|
|
|
Service Code
|
CPT 95953
|
| Hospital Charge Code |
900600212
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$9,183.60 |
| Rate for Payer: Adventist Health Commercial |
$2,040.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,196.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,612.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,653.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,400.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,935.67
|
| Rate for Payer: Blue Shield of California Commercial |
$6,428.52
|
| Rate for Payer: Blue Shield of California EPN |
$4,050.99
|
| Rate for Payer: Cash Price |
$4,591.80
|
| Rate for Payer: Cash Price |
$4,591.80
|
| Rate for Payer: Cash Price |
$4,591.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,163.20
|
| Rate for Payer: Cigna of CA HMO |
$6,530.56
|
| Rate for Payer: Cigna of CA PPO |
$7,550.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,673.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,673.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,081.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,081.60
|
| Rate for Payer: Galaxy Health WC |
$8,673.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,479.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,704.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,020.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,040.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,142.80
|
| Rate for Payer: Multiplan Commercial |
$7,653.00
|
| Rate for Payer: Networks By Design Commercial |
$6,632.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,673.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,081.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,673.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,673.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,673.40
|
|
|
HC EEG MONITOR 16+ CHAN, EA 24 HR
|
Facility
|
IP
|
$10,204.00
|
|
|
Service Code
|
CPT 95953
|
| Hospital Charge Code |
900600212
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,040.80 |
| Max. Negotiated Rate |
$9,183.60 |
| Rate for Payer: Adventist Health Commercial |
$2,040.80
|
| Rate for Payer: Cash Price |
$4,591.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,163.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,081.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,081.60
|
| Rate for Payer: Galaxy Health WC |
$8,673.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,183.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,479.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,020.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,040.80
|
| Rate for Payer: Multiplan Commercial |
$7,653.00
|
| Rate for Payer: Networks By Design Commercial |
$6,632.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,673.40
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$124.16 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,275.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$771.33
|
| Rate for Payer: Blue Shield of California Commercial |
$835.38
|
| Rate for Payer: Blue Shield of California EPN |
$526.42
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Cigna of CA HMO |
$848.64
|
| Rate for Payer: Cigna of CA PPO |
$981.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$795.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$795.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$265.20
|
| Rate for Payer: Cash Price |
$596.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$530.40
|
| Rate for Payer: Galaxy Health WC |
$1,127.10
|
| Rate for Payer: Global Benefits Group Commercial |
$795.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,193.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$842.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$782.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$994.50
|
| Rate for Payer: Networks By Design Commercial |
$861.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,127.10
|
|
|
HC EEG SEIZ MONT CABLE/RADIO 16CH
|
Facility
|
OP
|
$11,099.00
|
|
|
Service Code
|
CPT 95956
|
| Hospital Charge Code |
900600265
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$9,989.10 |
| Rate for Payer: Adventist Health Commercial |
$2,219.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,740.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,434.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,104.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,324.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,401.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,456.29
|
| Rate for Payer: Blue Shield of California Commercial |
$6,992.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,406.30
|
| Rate for Payer: Cash Price |
$4,994.55
|
| Rate for Payer: Cash Price |
$4,994.55
|
| Rate for Payer: Cash Price |
$4,994.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,879.20
|
| Rate for Payer: Cigna of CA HMO |
$7,103.36
|
| Rate for Payer: Cigna of CA PPO |
$8,213.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,434.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,434.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,434.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,769.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,439.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,439.60
|
| Rate for Payer: Galaxy Health WC |
$9,434.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,659.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,989.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,047.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,028.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,548.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,769.30
|
| Rate for Payer: Multiplan Commercial |
$8,324.25
|
| Rate for Payer: Networks By Design Commercial |
$7,214.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,434.15
|
| Rate for Payer: Riverside University Health System MISP |
$4,439.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,659.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,659.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,434.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,434.15
|
| Rate for Payer: Vantage Medical Group Senior |
$9,434.15
|
|
|
HC EEG SEIZ MONT CABLE/RADIO 16CH
|
Facility
|
IP
|
$11,099.00
|
|
|
Service Code
|
CPT 95956
|
| Hospital Charge Code |
900600265
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,219.80 |
| Max. Negotiated Rate |
$9,989.10 |
| Rate for Payer: Adventist Health Commercial |
$2,219.80
|
| Rate for Payer: Cash Price |
$4,994.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,879.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,769.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,439.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,439.60
|
| Rate for Payer: Galaxy Health WC |
$9,434.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,659.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,989.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,047.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,548.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,219.80
|
| Rate for Payer: Multiplan Commercial |
$8,324.25
|
| Rate for Payer: Networks By Design Commercial |
$7,214.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,434.15
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
IP
|
$4,171.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$834.20 |
| Max. Negotiated Rate |
$3,753.90 |
| Rate for Payer: Adventist Health Commercial |
$834.20
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,336.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,919.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,668.40
|
| Rate for Payer: Galaxy Health WC |
$3,545.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,753.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,648.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$834.20
|
| Rate for Payer: Multiplan Commercial |
$3,128.25
|
| Rate for Payer: Networks By Design Commercial |
$2,711.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,545.35
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
OP
|
$4,171.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$3,753.90 |
| Rate for Payer: Adventist Health Commercial |
$834.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,625.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,426.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2,627.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,655.89
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,336.80
|
| Rate for Payer: Cigna of CA HMO |
$2,669.44
|
| Rate for Payer: Cigna of CA PPO |
$3,086.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,919.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$3,545.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,753.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,648.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$834.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$3,128.25
|
| Rate for Payer: Networks By Design Commercial |
$2,711.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$3,545.35
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,502.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,502.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EEG VIDEO 16+ CHAN 12HR
|
Facility
|
IP
|
$15,926.00
|
|
|
Service Code
|
CPT 95951 52
|
| Hospital Charge Code |
900600621
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,185.20 |
| Max. Negotiated Rate |
$14,333.40 |
| Rate for Payer: Adventist Health Commercial |
$3,185.20
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,740.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,148.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,370.40
|
| Rate for Payer: Galaxy Health WC |
$13,537.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,333.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,113.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,396.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,185.20
|
| Rate for Payer: Multiplan Commercial |
$11,944.50
|
| Rate for Payer: Networks By Design Commercial |
$10,351.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,537.10
|
|
|
HC EEG VIDEO 16+ CHAN 12HR
|
Facility
|
OP
|
$15,926.00
|
|
|
Service Code
|
CPT 95951 52
|
| Hospital Charge Code |
900600621
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$14,333.40 |
| Rate for Payer: Adventist Health Commercial |
$3,185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,671.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,537.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,759.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,944.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,686.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,264.15
|
| Rate for Payer: Blue Shield of California Commercial |
$10,033.38
|
| Rate for Payer: Blue Shield of California EPN |
$6,322.62
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,740.80
|
| Rate for Payer: Cigna of CA HMO |
$10,192.64
|
| Rate for Payer: Cigna of CA PPO |
$11,785.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,537.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,537.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,537.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,148.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,370.40
|
| Rate for Payer: Galaxy Health WC |
$13,537.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,333.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,113.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,781.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,396.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,185.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,148.20
|
| Rate for Payer: Multiplan Commercial |
$11,944.50
|
| Rate for Payer: Networks By Design Commercial |
$10,351.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,537.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,370.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,555.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,555.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,537.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,537.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,537.10
|
|
|
HC EEG VIDEO 16+ CHAN 24HR
|
Facility
|
OP
|
$15,926.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
900600620
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$14,333.40 |
| Rate for Payer: Adventist Health Commercial |
$3,185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,671.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,537.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,759.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,944.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,686.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,264.15
|
| Rate for Payer: Blue Shield of California Commercial |
$10,033.38
|
| Rate for Payer: Blue Shield of California EPN |
$6,322.62
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,740.80
|
| Rate for Payer: Cigna of CA HMO |
$10,192.64
|
| Rate for Payer: Cigna of CA PPO |
$11,785.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,537.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,537.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,537.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,148.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,370.40
|
| Rate for Payer: Galaxy Health WC |
$13,537.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,333.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,113.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,781.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,396.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,185.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,148.20
|
| Rate for Payer: Multiplan Commercial |
$11,944.50
|
| Rate for Payer: Networks By Design Commercial |
$10,351.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,537.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,370.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,555.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,555.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,537.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,537.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,537.10
|
|
|
HC EEG VIDEO 16+ CHAN 24HR
|
Facility
|
IP
|
$15,926.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
900600620
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,185.20 |
| Max. Negotiated Rate |
$14,333.40 |
| Rate for Payer: Adventist Health Commercial |
$3,185.20
|
| Rate for Payer: Cash Price |
$7,166.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,740.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,148.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,370.40
|
| Rate for Payer: Galaxy Health WC |
$13,537.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,333.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,113.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,396.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,185.20
|
| Rate for Payer: Multiplan Commercial |
$11,944.50
|
| Rate for Payer: Networks By Design Commercial |
$10,351.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,537.10
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$1,124.10 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$499.60
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$736.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,947.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$726.54
|
| Rate for Payer: Blue Shield of California Commercial |
$786.87
|
| Rate for Payer: Blue Shield of California EPN |
$495.85
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Cigna of CA HMO |
$799.36
|
| Rate for Payer: Cigna of CA PPO |
$924.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,100.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,215.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$749.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$749.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$1,124.10 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$499.60
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$736.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,356.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$726.54
|
| Rate for Payer: Blue Shield of California Commercial |
$786.87
|
| Rate for Payer: Blue Shield of California EPN |
$495.85
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Cigna of CA HMO |
$799.36
|
| Rate for Payer: Cigna of CA PPO |
$924.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$749.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$749.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
