|
HC EDUCATION MENTAL HEALTH
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804065
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.01
|
| Rate for Payer: Blue Distinction Transplant |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.42
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
OP
|
$2,236.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$2,012.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,440.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,321.03
|
| Rate for Payer: Blue Distinction Transplant |
$1,341.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,381.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,086.70
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,788.80
|
| Rate for Payer: Cigna of CA HMO |
$1,431.04
|
| Rate for Payer: Cigna of CA PPO |
$1,654.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,900.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,341.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,012.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,677.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,491.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,677.00
|
| Rate for Payer: Networks By Design Commercial |
$1,453.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,900.60
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,341.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,341.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG,AWAKE/DROWSY
|
Facility
|
IP
|
$2,236.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
900600228
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$447.20 |
| Max. Negotiated Rate |
$2,012.40 |
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$894.40
|
| Rate for Payer: Galaxy Health WC |
$1,900.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,341.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,012.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,491.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$851.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.20
|
| Rate for Payer: Multiplan Commercial |
$1,677.00
|
| Rate for Payer: Networks By Design Commercial |
$1,453.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,900.60
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,646.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,961.46
|
| Rate for Payer: Blue Distinction Transplant |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,613.52
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.00
|
| Rate for Payer: Cigna of CA HMO |
$2,124.80
|
| Rate for Payer: Cigna of CA PPO |
$2,456.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,822.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,490.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,490.00
|
| Rate for Payer: Networks By Design Commercial |
$2,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.00
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG AWAKE SLEEP
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
900600227
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$664.00 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Cash Price |
$1,494.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.00
|
| Rate for Payer: Galaxy Health WC |
$2,822.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.00
|
| Rate for Payer: Multiplan Commercial |
$2,490.00
|
| Rate for Payer: Networks By Design Commercial |
$2,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.00
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,403.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.72
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$583.39
|
| Rate for Payer: Blue Shield of California EPN |
$458.78
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EEG CONT REC W/VID EEG TECH
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95700
|
| Hospital Charge Code |
900605700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
IP
|
$5,119.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,023.80 |
| Max. Negotiated Rate |
$4,607.10 |
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,095.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.60
|
| Rate for Payer: Galaxy Health WC |
$4,351.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,071.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,607.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,414.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.80
|
| Rate for Payer: Multiplan Commercial |
$3,839.25
|
| Rate for Payer: Networks By Design Commercial |
$3,327.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,351.15
|
|
|
HC EEG DURING NONINTRACRANIAL INT
|
Facility
|
OP
|
$5,119.00
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
900600354
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$4,607.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$714.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,351.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,815.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,815.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,024.31
|
| Rate for Payer: Blue Distinction Transplant |
$3,071.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,163.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,487.83
|
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Cash Price |
$2,303.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,095.20
|
| Rate for Payer: Cigna of CA HMO |
$3,276.16
|
| Rate for Payer: Cigna of CA PPO |
$3,788.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,351.15
|
| Rate for Payer: Dignity Health Media |
$4,351.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,351.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,047.60
|
| Rate for Payer: Galaxy Health WC |
$4,351.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,071.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,607.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,839.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,791.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,414.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.80
|
| Rate for Payer: Multiplan Commercial |
$3,839.25
|
| Rate for Payer: Networks By Design Commercial |
$3,327.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,351.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,047.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,071.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,071.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,351.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,351.15
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$2,696.00 |
| 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 |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,384.20
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,845.60
|
| Rate for Payer: Cigna of CA PPO |
$1,707.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,960.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,384.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,076.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,730.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,538.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,730.25
|
| Rate for Payer: Networks By Design Commercial |
$1,499.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,960.95
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,153.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$461.40 |
| Max. Negotiated Rate |
$2,076.30 |
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,845.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$922.80
|
| Rate for Payer: Galaxy Health WC |
$1,960.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,384.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,076.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,538.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.40
|
| Rate for Payer: Multiplan Commercial |
$1,730.25
|
| Rate for Payer: Networks By Design Commercial |
$1,499.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,960.95
|
|
|
HC EEG FOR ECS
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$2,879.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$747.95
|
| Rate for Payer: Blue Distinction Transplant |
$759.60
|
| Rate for Payer: Blue Shield of California Commercial |
$782.39
|
| Rate for Payer: Blue Shield of California EPN |
$615.28
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.80
|
| Rate for Payer: Cigna of CA HMO |
$810.24
|
| Rate for Payer: Cigna of CA PPO |
$936.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,139.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$949.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$949.50
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG FOR ECS
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 95824
|
| Hospital Charge Code |
900600214
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$1,139.40 |
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.40
|
| Rate for Payer: Galaxy Health WC |
$1,076.10
|
| Rate for Payer: Global Benefits Group Commercial |
$759.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,139.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.20
|
| Rate for Payer: Multiplan Commercial |
$949.50
|
| Rate for Payer: Networks By Design Commercial |
$822.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.10
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
IP
|
$3,815.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$763.00 |
| Max. Negotiated Rate |
$3,433.50 |
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,052.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.00
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,433.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,453.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,861.25
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
|
|
HC EEG GREATER THAN ONE HOUR
|
Facility
|
OP
|
$3,815.00
|
|
|
Service Code
|
CPT 95813
|
| Hospital Charge Code |
900600207
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$211.55 |
| Max. Negotiated Rate |
$3,433.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,631.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,253.90
|
| Rate for Payer: Blue Distinction Transplant |
$2,289.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,357.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,854.09
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,052.00
|
| Rate for Payer: Cigna of CA HMO |
$2,441.60
|
| Rate for Payer: Cigna of CA PPO |
$2,823.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,433.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,861.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,861.25
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,289.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,289.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$124.16 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,190.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.57
|
| Rate for Payer: Blue Distinction Transplant |
$601.80
|
| Rate for Payer: Blue Shield of California Commercial |
$619.85
|
| Rate for Payer: Blue Shield of California EPN |
$487.46
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Central Health Plan Commercial |
$802.40
|
| Rate for Payer: Cigna of CA HMO |
$641.92
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$902.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$752.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$752.25
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG MONITORING/GIVING DRUGS
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 95954
|
| Hospital Charge Code |
900600230
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Central Health Plan Commercial |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$902.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.60
|
| Rate for Payer: Multiplan Commercial |
$752.25
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
IP
|
$3,154.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$630.80 |
| Max. Negotiated Rate |
$2,838.60 |
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,523.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.60
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,838.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.80
|
| Rate for Payer: Multiplan Commercial |
$2,365.50
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
|
|
HC EEG SLEEP ONLY
|
Facility
|
OP
|
$3,154.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$2,838.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,518.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,863.38
|
| Rate for Payer: Blue Distinction Transplant |
$1,892.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,949.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,532.84
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,523.20
|
| Rate for Payer: Cigna of CA HMO |
$2,018.56
|
| Rate for Payer: Cigna of CA PPO |
$2,333.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,838.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,365.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,365.50
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,892.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,892.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,919.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.72
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$583.39
|
| Rate for Payer: Blue Shield of California EPN |
$458.78
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,215.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,333.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.72
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$583.39
|
| Rate for Payer: Blue Shield of California EPN |
$458.78
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$560.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.72
|
| Rate for Payer: Blue Distinction Transplant |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$583.39
|
| Rate for Payer: Blue Shield of California EPN |
$458.78
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: Cigna of CA HMO |
$604.16
|
| Rate for Payer: Cigna of CA PPO |
$698.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Central Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.60
|
| Rate for Payer: Galaxy Health WC |
$802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$566.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$629.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$802.40
|
|
