|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
915357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22,799.20 |
| Max. Negotiated Rate |
$102,596.40 |
| Rate for Payer: Adventist Health Commercial |
$22,799.20
|
| Rate for Payer: Blue Shield of California Commercial |
$88,118.91
|
| Rate for Payer: Blue Shield of California EPN |
$57,453.98
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Central Health Plan Commercial |
$91,196.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$102,596.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,432.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,799.20
|
| Rate for Payer: Multiplan Commercial |
$85,497.00
|
| Rate for Payer: Networks By Design Commercial |
$74,097.40
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
|
|
HC ELECTRICAL STIMULATION UA OT
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
903200050
|
|
Hospital Revenue Code
|
430
|
| 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: LLUH Dept of Risk Management WC |
$71.80
|
| 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 ELECTRICAL STIMULATION UA OT
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
903200050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$147.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$161.55
|
| 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 |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$179.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.30
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$143.60
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
HC ELECTROCONVULSIVE THERAPY
|
Facility
|
OP
|
$2,886.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
907702200
|
|
Hospital Revenue Code
|
901
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$2,597.40 |
| Rate for Payer: Adventist Health Commercial |
$577.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,752.67
|
| 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 |
$1,397.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,694.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,308.80
|
| Rate for Payer: Cigna of CA HMO |
$1,847.04
|
| Rate for Payer: Cigna of CA PPO |
$2,135.64
|
| 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 |
$2,453.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,731.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,597.40
|
| Rate for Payer: Health Net Behavioral |
$1,300.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.32
|
| 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 |
$1,924.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.20
|
| 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 |
$2,164.50
|
| Rate for Payer: Networks By Design Commercial |
$1,875.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,453.10
|
| 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 |
$1,731.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,731.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,443.00
|
| 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 ELECTROCONVULSIVE THERAPY
|
Facility
|
IP
|
$2,886.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
907702200
|
|
Hospital Revenue Code
|
901
|
| Min. Negotiated Rate |
$577.20 |
| Max. Negotiated Rate |
$2,597.40 |
| Rate for Payer: Adventist Health Commercial |
$577.20
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,308.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,154.40
|
| Rate for Payer: Galaxy Health WC |
$2,453.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,731.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,597.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,924.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,099.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,786.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.20
|
| Rate for Payer: Multiplan Commercial |
$2,164.50
|
| Rate for Payer: Networks By Design Commercial |
$1,875.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,453.10
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$382.67 |
| Max. Negotiated Rate |
$9,255.04 |
| Rate for Payer: Adventist Health Commercial |
$389.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,183.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,655.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,071.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,461.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,255.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,144.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.44
|
| Rate for Payer: Blue Shield of California EPN |
$773.36
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,558.40
|
| Rate for Payer: Cigna of CA HMO |
$1,246.72
|
| Rate for Payer: Cigna of CA PPO |
$1,441.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,655.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,655.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,655.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.20
|
| Rate for Payer: EPIC Health Plan Senior |
$779.20
|
| Rate for Payer: Galaxy Health WC |
$1,655.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,753.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$382.67
|
| Rate for Payer: InnovAge PACE Commercial |
$974.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,205.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,363.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,363.60
|
| Rate for Payer: Multiplan Commercial |
$1,461.00
|
| Rate for Payer: Networks By Design Commercial |
$1,266.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,655.80
|
| Rate for Payer: Riverside University Health System MISP |
$779.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,168.80
|
| 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 |
$1,655.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,655.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,655.80
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$389.60 |
| Max. Negotiated Rate |
$1,753.20 |
| Rate for Payer: Adventist Health Commercial |
$389.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$779.20
|
| Rate for Payer: EPIC Health Plan Senior |
$779.20
|
| Rate for Payer: Galaxy Health WC |
$1,655.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,753.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,205.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.60
|
| Rate for Payer: Multiplan Commercial |
$1,461.00
|
| Rate for Payer: Networks By Design Commercial |
$1,266.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,655.80
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$750.40 |
| Max. Negotiated Rate |
$3,376.80 |
| Rate for Payer: Adventist Health Commercial |
$750.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,001.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,500.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,500.80
|
| Rate for Payer: Galaxy Health WC |
$3,189.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,251.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,376.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,429.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,322.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.40
|
| Rate for Payer: Multiplan Commercial |
$2,814.00
|
| Rate for Payer: Networks By Design Commercial |
$2,438.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,189.20
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
|
OP
|
$2,072.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$414.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$769.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.89
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,657.60
|
| Rate for Payer: Cigna of CA HMO |
$1,326.08
|
| Rate for Payer: Cigna of CA PPO |
$1,533.28
|
| 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 |
$1,761.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,864.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.75
|
| 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 |
$1,382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.40
|
| 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 |
$1,554.00
|
| Rate for Payer: Networks By Design Commercial |
$1,346.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,761.20
|
| 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 |
$1,243.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 ELECTROLYTE PANEL
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.36
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.01
|
| Rate for Payer: InnovAge PACE Commercial |
$10.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.01
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$7.43
|
| Rate for Payer: Riverside University Health System MISP |
$7.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$116.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$354.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.40
|
| Rate for Payer: Blue Shield of California Commercial |
$353.88
|
| Rate for Payer: Blue Shield of California EPN |
$231.45
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$524.70 |
| Rate for Payer: Adventist Health Commercial |
$116.60
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.60
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.61
|
| 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 |
$49.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.27
|
| Rate for Payer: Blue Shield of California Commercial |
$283.47
|
| Rate for Payer: Blue Shield of California EPN |
$185.40
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: Cigna of CA HMO |
$298.88
|
| Rate for Payer: Cigna of CA PPO |
$345.58
|
| 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 |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.33
|
| 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 |
$311.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| 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 |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
| 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 |
$280.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Cash Price |
$210.15
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$311.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
|
|
HC ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$518.03
|
| 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 |
$178.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.97
|
| Rate for Payer: Blue Shield of California Commercial |
$517.77
|
| Rate for Payer: Blue Shield of California EPN |
$338.64
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Central Health Plan Commercial |
$682.40
|
| Rate for Payer: Cigna of CA HMO |
$545.92
|
| Rate for Payer: Cigna of CA PPO |
$631.22
|
| 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 |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$767.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.99
|
| 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 |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.60
|
| 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 |
$639.75
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
| 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 |
$511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$767.70 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Central Health Plan Commercial |
$682.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$341.20
|
| Rate for Payer: Galaxy Health WC |
$725.05
|
| Rate for Payer: Global Benefits Group Commercial |
$511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$767.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.60
|
| Rate for Payer: Multiplan Commercial |
$639.75
|
| Rate for Payer: Networks By Design Commercial |
$554.45
|
| Rate for Payer: Prime Health Services Commercial |
$725.05
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
OP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
915357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,100.00 |
| Max. Negotiated Rate |
$36,000.00 |
| Rate for Payer: Adventist Health Commercial |
$16,400.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22,000.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,492.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30,920.00
|
| Rate for Payer: Blue Shield of California EPN |
$20,160.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Central Health Plan Commercial |
$32,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,000.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,000.00
|
| Rate for Payer: InnovAge PACE Commercial |
$20,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,400.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,000.00
|
| Rate for Payer: Multiplan Commercial |
$30,000.00
|
| Rate for Payer: Networks By Design Commercial |
$20,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: Riverside University Health System MISP |
$16,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34,000.00
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
OP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
905357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,100.00 |
| Max. Negotiated Rate |
$36,000.00 |
| Rate for Payer: Adventist Health Commercial |
$16,400.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22,000.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,492.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30,920.00
|
| Rate for Payer: Blue Shield of California EPN |
$20,160.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Central Health Plan Commercial |
$32,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,000.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,000.00
|
| Rate for Payer: InnovAge PACE Commercial |
$20,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,400.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,000.00
|
| Rate for Payer: Multiplan Commercial |
$30,000.00
|
| Rate for Payer: Networks By Design Commercial |
$20,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: Riverside University Health System MISP |
$16,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,000.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34,000.00
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
IP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
915357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,000.00 |
| Max. Negotiated Rate |
$36,000.00 |
| Rate for Payer: Adventist Health Commercial |
$8,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30,920.00
|
| Rate for Payer: Blue Shield of California EPN |
$20,160.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Central Health Plan Commercial |
$32,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,240.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,000.00
|
| Rate for Payer: Multiplan Commercial |
$30,000.00
|
| Rate for Payer: Networks By Design Commercial |
$26,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
|
|
HC ELECTRONIC ELBO SIMULTANEOUS
|
Facility
|
IP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
905357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,000.00 |
| Max. Negotiated Rate |
$36,000.00 |
| Rate for Payer: Adventist Health Commercial |
$8,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30,920.00
|
| Rate for Payer: Blue Shield of California EPN |
$20,160.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| Rate for Payer: Central Health Plan Commercial |
$32,000.00
|
| Rate for Payer: Cigna of CA HMO |
$28,000.00
|
| Rate for Payer: Cigna of CA PPO |
$28,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16,000.00
|
| Rate for Payer: Galaxy Health WC |
$34,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,240.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,760.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,000.00
|
| Rate for Payer: Multiplan Commercial |
$30,000.00
|
| Rate for Payer: Networks By Design Commercial |
$26,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$34,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,296.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,100.00
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
|
IP
|
$3,833.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$766.60 |
| Max. Negotiated Rate |
$3,449.70 |
| Rate for Payer: Adventist Health Commercial |
$766.60
|
| Rate for Payer: Cash Price |
$1,724.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,066.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,533.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,533.20
|
| Rate for Payer: Galaxy Health WC |
$3,258.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,299.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,449.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,556.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,460.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,372.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.60
|
| Rate for Payer: Multiplan Commercial |
$2,874.75
|
| Rate for Payer: Networks By Design Commercial |
$2,491.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,258.05
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.06
|
| Rate for Payer: Blue Shield of California Commercial |
$664.66
|
| Rate for Payer: Blue Shield of California EPN |
$434.71
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
IP
|
$6,277.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,255.40 |
| Max. Negotiated Rate |
$5,649.30 |
| Rate for Payer: Adventist Health Commercial |
$1,255.40
|
| Rate for Payer: Cash Price |
$2,824.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,021.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,510.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,510.80
|
| Rate for Payer: Galaxy Health WC |
$5,335.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,649.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,885.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.40
|
| Rate for Payer: Multiplan Commercial |
$4,707.75
|
| Rate for Payer: Networks By Design Commercial |
$4,080.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,335.45
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
|
IP
|
$6,277.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,255.40 |
| Max. Negotiated Rate |
$5,649.30 |
| Rate for Payer: Adventist Health Commercial |
$1,255.40
|
| Rate for Payer: Cash Price |
$2,824.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,021.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,510.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,510.80
|
| Rate for Payer: Galaxy Health WC |
$5,335.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,649.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,885.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.40
|
| Rate for Payer: Multiplan Commercial |
$4,707.75
|
| Rate for Payer: Networks By Design Commercial |
$4,080.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,335.45
|
|
