|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
OP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
905357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,734.20 |
| Max. Negotiated Rate |
$40,882.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,882.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,296.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,296.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,466.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,431.33
|
| Rate for Payer: BCBS Transplant Transplant |
$16,687.20
|
| Rate for Payer: Blue Shield of California Commercial |
$20,859.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,129.73
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,249.60
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,640.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,030.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20,859.00
|
| Rate for Payer: IEHP medi-cal |
$9,734.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,402.92
|
| Rate for Payer: Multiplan Commercial |
$20,859.00
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: Riverside University Health MISP |
$11,124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,687.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,687.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,906.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,906.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,906.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,906.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,640.20
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
IP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
905357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,562.40 |
| Max. Negotiated Rate |
$25,030.80 |
| Rate for Payer: Blue Shield of California EPN |
$14,851.61
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,249.60
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,030.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,562.40
|
| Rate for Payer: Multiplan Commercial |
$20,859.00
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
IP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
905357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,308.00 |
| Max. Negotiated Rate |
$23,886.00 |
| Rate for Payer: Blue Shield of California EPN |
$14,172.36
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,232.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,886.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,308.00
|
| Rate for Payer: Multiplan Commercial |
$19,905.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
OP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
905357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,289.00 |
| Max. Negotiated Rate |
$39,124.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,124.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,597.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14,597.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,850.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,679.83
|
| Rate for Payer: BCBS Transplant Transplant |
$15,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,905.00
|
| Rate for Payer: Blue Shield of California EPN |
$14,437.76
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,232.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,559.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,886.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,905.00
|
| Rate for Payer: IEHP medi-cal |
$9,289.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,881.40
|
| Rate for Payer: Multiplan Commercial |
$19,905.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: Riverside University Health MISP |
$10,616.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,270.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,559.00
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,956.65 |
| Max. Negotiated Rate |
$25,934.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,934.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,360.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,240.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,054.83
|
| Rate for Payer: BCBS Transplant Transplant |
$10,211.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,764.25
|
| Rate for Payer: Blue Shield of California EPN |
$9,258.34
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,615.20
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,317.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,764.25
|
| Rate for Payer: IEHP medi-cal |
$5,956.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,977.79
|
| Rate for Payer: Multiplan Commercial |
$12,764.25
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Riverside University Health MISP |
$6,807.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,509.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,509.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,509.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,509.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$15,317.10 |
| Rate for Payer: Blue Shield of California EPN |
$9,088.15
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,615.20
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,317.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,403.80
|
| Rate for Payer: Multiplan Commercial |
$12,764.25
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22,799.20 |
| Max. Negotiated Rate |
$102,596.40 |
| Rate for Payer: Blue Shield of California EPN |
$60,873.86
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$22,799.20
|
| Rate for Payer: Multiplan Commercial |
$85,497.00
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39,898.60 |
| Max. Negotiated Rate |
$144,487.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$144,487.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62,697.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55,196.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67,348.84
|
| Rate for Payer: BCBS Transplant Transplant |
$68,397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85,497.00
|
| Rate for Payer: Blue Shield of California EPN |
$62,013.82
|
| Rate for Payer: Cash Price |
$51,298.20
|
| 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: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$85,497.00
|
| Rate for Payer: IEHP medi-cal |
$39,898.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46,738.36
|
| Rate for Payer: Multiplan Commercial |
$85,497.00
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Riverside University Health MISP |
$45,598.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56,998.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,998.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56,998.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56,998.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
|
HC ELECTRICAL STIMULATION UA OT
|
Facility
OP
|
$403.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
903200050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$342.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$221.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$221.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$241.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Cigna of CA HMO |
$257.92
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$302.25
|
| Rate for Payer: IEHP medi-cal |
$141.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.23
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: Riverside University Health MISP |
$161.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$342.55
|
| Rate for Payer: Vantage Medical Group Senior |
$342.55
|
|
|
HC ELECTRICAL STIMULATION UA OT
|
Facility
IP
|
$403.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
903200050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
OP
|
$1,783.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$356.60 |
| Max. Negotiated Rate |
$9,255.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,202.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,515.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$980.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$980.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,255.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,053.40
|
| Rate for Payer: BCBS Transplant Transplant |
$1,069.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.89
|
| Rate for Payer: Blue Shield of California EPN |
$866.54
|
| Rate for Payer: Cash Price |
$802.35
|
| Rate for Payer: Cash Price |
$802.35
|
| Rate for Payer: Cash Price |
$802.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,426.40
|
| Rate for Payer: Cigna of CA HMO |
$1,141.12
|
| Rate for Payer: Cigna of CA PPO |
$1,319.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,515.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$713.20
|
| Rate for Payer: Galaxy Health WC |
$1,515.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,604.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,337.25
|
| Rate for Payer: IEHP medi-cal |
$624.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,189.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.60
|
| Rate for Payer: Multiplan Commercial |
$1,337.25
|
| Rate for Payer: Networks By Design Commercial |
$1,158.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,515.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,069.80
|
| Rate for Payer: Riverside University Health MISP |
$713.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,069.80
|
| 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 Medi-Cal |
$1,515.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,515.55
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
IP
|
$1,783.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$356.60 |
| Max. Negotiated Rate |
$1,604.70 |
| Rate for Payer: Cash Price |
$802.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,426.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.20
|
| Rate for Payer: Galaxy Health WC |
$1,515.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,604.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,189.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.60
|
| Rate for Payer: Multiplan Commercial |
$1,337.25
|
| Rate for Payer: Networks By Design Commercial |
$1,158.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,515.55
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$687.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$769.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$925.78
|
| Rate for Payer: BCBS Transplant Transplant |
$940.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,253.60
|
| Rate for Payer: Cigna of CA PPO |
$1,159.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| 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 |
$1,331.95
|
| Rate for Payer: Global Benefits Group Commercial |
$940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,410.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,175.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: IEHP medi-cal |
$647.08
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Innovage PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.40
|
| 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 |
$1,175.25
|
| Rate for Payer: Networks By Design Commercial |
$1,018.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.95
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$431.39
|
| Rate for Payer: Riverside University Health MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| 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 ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
IP
|
$2,837.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$567.40 |
| Max. Negotiated Rate |
$2,553.30 |
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,269.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.80
|
| Rate for Payer: Galaxy Health WC |
$2,411.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,553.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.40
|
| Rate for Payer: Multiplan Commercial |
$2,127.75
|
| Rate for Payer: Networks By Design Commercial |
$1,844.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,411.45
|
|
|
HC ELECTROLYTE PANEL
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$62.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: AlphaCare 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 |
$62.25
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.50
|
| Rate for Payer: IEHP medi-cal |
$11.57
|
| Rate for Payer: IEHP Medicare Advantage |
$7.01
|
| Rate for Payer: Innovage PACE Commercial |
$10.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| 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 |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$7.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$7.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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: 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
|
$246.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Central Health Plan Commercial |
$392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.40
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$327.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.20
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.08
|
| Rate for Payer: BCBS Transplant Transplant |
$294.60
|
| Rate for Payer: Blue Shield of California Commercial |
$303.44
|
| Rate for Payer: Blue Shield of California EPN |
$238.63
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Central Health Plan Commercial |
$392.80
|
| Rate for Payer: Cigna of CA HMO |
$314.24
|
| Rate for Payer: Cigna of CA PPO |
$363.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$368.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: IEHP medi-cal |
$263.34
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Innovage PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$294.60
|
| Rate for Payer: Riverside University Health MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.18
|
| Rate for Payer: BCBS Transplant Transplant |
$235.80
|
| Rate for Payer: Blue Shield of California Commercial |
$242.87
|
| Rate for Payer: Blue Shield of California EPN |
$191.00
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| 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 |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$294.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| 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 |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 ELECTROMYOGRAPHY NEEDL/HEMIDIA
|
Facility
IP
|
$393.00
|
|
|
Service Code
|
CPT 95866
|
| Hospital Charge Code |
900600241
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
IP
|
$645.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.00
|
| Rate for Payer: Galaxy Health WC |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
|
|
HC ELECTROMYOGRAPHY NEEDL/ONE FIB
|
Facility
OP
|
$645.00
|
|
|
Service Code
|
CPT 95872
|
| Hospital Charge Code |
900600244
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$178.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.07
|
| Rate for Payer: BCBS Transplant Transplant |
$387.00
|
| Rate for Payer: Blue Shield of California Commercial |
$398.61
|
| Rate for Payer: Blue Shield of California EPN |
$313.47
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: Cigna of CA HMO |
$412.80
|
| Rate for Payer: Cigna of CA PPO |
$477.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| 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 |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$483.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| 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 |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$387.00
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| 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 ELECTRONIC ELBO SIMULTANEOUS
|
Facility
OP
|
$40,000.00
|
|
|
Service Code
|
CPT L7181
|
| Hospital Charge Code |
905357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14,000.00 |
| Max. Negotiated Rate |
$159,237.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$159,237.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,000.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22,000.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,368.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,632.00
|
| Rate for Payer: BCBS Transplant Transplant |
$24,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30,000.00
|
| Rate for Payer: Blue Shield of California EPN |
$21,760.00
|
| Rate for Payer: Cash Price |
$18,000.00
|
| 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: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$30,000.00
|
| Rate for Payer: IEHP medi-cal |
$14,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,680.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,400.00
|
| 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 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 |
$20,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20,000.00
|
| 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 |
905357181
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,000.00 |
| Max. Negotiated Rate |
$36,000.00 |
| Rate for Payer: Blue Shield of California EPN |
$21,360.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$8,000.00
|
| 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
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
IP
|
$4,463.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$892.60 |
| Max. Negotiated Rate |
$4,016.70 |
| Rate for Payer: Cash Price |
$2,008.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.20
|
| Rate for Payer: Galaxy Health WC |
$3,793.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,016.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,976.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.60
|
| Rate for Payer: Multiplan Commercial |
$3,347.25
|
| Rate for Payer: Networks By Design Commercial |
$2,900.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,793.55
|
|
