|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
OP
|
$4,696.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
915356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,386.30 |
| Max. Negotiated Rate |
$4,226.40 |
| Rate for Payer: Adventist Health Commercial |
$1,925.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,582.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,522.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,757.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,630.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,366.78
|
| Rate for Payer: Cash Price |
$2,113.20
|
| Rate for Payer: Cash Price |
$2,113.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,756.80
|
| Rate for Payer: Cigna of CA HMO |
$3,287.20
|
| Rate for Payer: Cigna of CA PPO |
$3,287.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,991.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,991.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,878.40
|
| Rate for Payer: Galaxy Health WC |
$3,991.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,817.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,226.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,386.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,132.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,906.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,925.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,287.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,287.20
|
| Rate for Payer: Multiplan Commercial |
$3,522.00
|
| Rate for Payer: Networks By Design Commercial |
$2,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,991.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,878.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,817.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,817.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,762.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,715.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,678.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,537.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,991.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,991.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,991.60
|
|
|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
905356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.30 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Adventist Health Commercial |
$869.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,245.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,638.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.48
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,696.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,908.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,386.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,060.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,484.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,590.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: Riverside University Health System MISP |
$848.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.00
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
905356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,332.20 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.20
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$4,329.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
IP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
915356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,332.20 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$1,332.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.20
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$4,329.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
905356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.12 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$2,731.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,912.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,964.12
|
| Rate for Payer: InnovAge PACE Commercial |
$3,330.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,731.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,662.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,662.70
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.85
|
|
|
HC ED MOLD SKT OUTSIDE LOCKNG HNG
|
Facility
|
OP
|
$6,661.00
|
|
|
Service Code
|
CPT L6200
|
| Hospital Charge Code |
915356200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,964.12 |
| Max. Negotiated Rate |
$5,994.90 |
| Rate for Payer: Adventist Health Commercial |
$2,731.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,663.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,995.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,912.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,148.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.14
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Cash Price |
$2,997.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,328.80
|
| Rate for Payer: Cigna of CA HMO |
$4,662.70
|
| Rate for Payer: Cigna of CA PPO |
$4,662.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,661.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,661.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,664.40
|
| Rate for Payer: Galaxy Health WC |
$5,661.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,996.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,994.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,964.12
|
| Rate for Payer: InnovAge PACE Commercial |
$3,330.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,442.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,731.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,662.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,662.70
|
| Rate for Payer: Multiplan Commercial |
$4,995.75
|
| Rate for Payer: Networks By Design Commercial |
$3,330.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,661.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,996.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,996.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2,433.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,181.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,661.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,661.85
|
|
|
HC ED OT TASK GROUP
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804115
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Central Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.22
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
|
|
HC ED OT TASK GROUP
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804115
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$173.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.84
|
| Rate for Payer: Blue Shield of California Commercial |
$219.35
|
| Rate for Payer: Blue Shield of California EPN |
$143.24
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Central Health Plan Commercial |
$287.20
|
| Rate for Payer: Cigna of CA HMO |
$229.76
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.10
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC EDUCATION ED MENTAL HEALTH
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$157.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.11
|
| Rate for Payer: Blue Shield of California Commercial |
$235.24
|
| Rate for Payer: Blue Shield of California EPN |
$153.62
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC EDUCATION ED MENTAL HEALTH
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC EDUCATION MENTAL HEALTH
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804065
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC EDUCATION MENTAL HEALTH
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804065
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
OP
|
$2,957.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$2,661.30 |
| Rate for Payer: Adventist Health Commercial |
$591.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,795.79
|
| 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 Exchange |
$444.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,736.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,794.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,173.93
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,365.60
|
| Rate for Payer: Cigna of CA HMO |
$1,892.48
|
| Rate for Payer: Cigna of CA PPO |
$2,188.18
|
| 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 |
$2,513.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,774.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,661.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,217.75
|
| Rate for Payer: Networks By Design Commercial |
$1,922.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$2,513.45
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,774.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,774.20
|
| 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 |
$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 EEG,AWAKE/DROWSY
|
Facility
|
IP
|
$2,957.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$591.40 |
| Max. Negotiated Rate |
$2,661.30 |
| Rate for Payer: Adventist Health Commercial |
$591.40
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,182.80
|
| Rate for Payer: Galaxy Health WC |
$2,513.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,774.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,661.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,126.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,830.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$591.40
|
| Rate for Payer: Multiplan Commercial |
$2,217.75
|
| Rate for Payer: Networks By Design Commercial |
$1,922.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,513.45
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
OP
|
$4,391.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$3,951.90 |
| Rate for Payer: Adventist Health Commercial |
$878.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,666.65
|
| 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 Exchange |
$361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,578.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,665.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,743.23
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: Cigna of CA HMO |
$2,810.24
|
| Rate for Payer: Cigna of CA PPO |
$3,249.34
|
| 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 |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,634.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,634.60
|
| 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 |
$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 EEG AWAKE SLEEP
|
Facility
|
IP
|
$4,391.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$878.20 |
| Max. Negotiated Rate |
$3,951.90 |
| Rate for Payer: Adventist Health Commercial |
$878.20
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,756.40
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,319.06
|
| 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 Exchange |
$1,888.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,275.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.40
|
| Rate for Payer: Blue Shield of California EPN |
$862.28
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,737.60
|
| Rate for Payer: Cigna of CA HMO |
$1,390.08
|
| Rate for Payer: Cigna of CA PPO |
$1,607.28
|
| 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 |
$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: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,629.00
|
| Rate for Payer: Networks By Design Commercial |
$1,411.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,303.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,303.20
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,344.47
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4,515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,579.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,190.63
|
| 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 |
$4,111.42
|
| 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 |
$3,976.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4,109.39
|
| 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: 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: InnovAge PACE Commercial |
$3,385.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,190.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,739.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,035.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,888.57
|
| 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 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 |
$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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$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 |
$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 |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,035.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| 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 |
$395.66
|
| 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 |
$419.40
|
| Rate for Payer: Prime Health Services WC |
$623.98
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| 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 |
$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 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 |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,016.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$983.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.12
|
| 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 |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,116.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| 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 |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| 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 |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$1,116.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,036.21
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,365.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,922.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,122.86
|
| 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
|
|
