|
HC NEEDLE ELEC THOR/SPINAL MUSC
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
900600254
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$212.45
|
| Rate for Payer: Blue Shield of California EPN |
$138.95
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEEDLE ELEC THOR/SPINAL MUSC
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
900600254
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC NEEDLE EMG 1 EXT W/ WO PARASP
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
900600233
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$671.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$648.97
|
| Rate for Payer: Blue Shield of California Commercial |
$670.74
|
| Rate for Payer: Blue Shield of California EPN |
$438.69
|
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Central Health Plan Commercial |
$884.00
|
| Rate for Payer: Cigna of CA HMO |
$707.20
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$994.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$112.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$663.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEEDLE EMG 1 EXT W/ WO PARASP
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
900600233
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$221.00
|
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Central Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: EPIC Health Plan Senior |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$994.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$684.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,145.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,108.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.41
|
| Rate for Payer: Blue Shield of California EPN |
$749.14
|
| Rate for Payer: Cash Price |
$1,037.85
|
| Rate for Payer: Cash Price |
$1,037.85
|
| Rate for Payer: Cash Price |
$1,037.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Cigna of CA HMO |
$1,207.68
|
| Rate for Payer: Cigna of CA PPO |
$1,396.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,603.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,698.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,258.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
| Rate for Payer: Networks By Design Commercial |
$1,226.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,603.95
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,132.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,132.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
|
IP
|
$1,887.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Cash Price |
$1,037.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,509.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$754.80
|
| Rate for Payer: EPIC Health Plan Senior |
$754.80
|
| Rate for Payer: Galaxy Health WC |
$1,603.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,698.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,258.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$718.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,168.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
| Rate for Payer: Networks By Design Commercial |
$1,226.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,603.95
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,367.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.30
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,367.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.30
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$971.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$952.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$921.47
|
| Rate for Payer: Blue Shield of California Commercial |
$952.38
|
| Rate for Payer: Blue Shield of California EPN |
$622.89
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$971.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$952.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$921.47
|
| Rate for Payer: Blue Shield of California Commercial |
$952.38
|
| Rate for Payer: Blue Shield of California EPN |
$622.89
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Cash Price |
$862.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,046.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC NEFF SET
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC NEFF SET
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$274.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.46
|
| Rate for Payer: Blue Shield of California Commercial |
$276.17
|
| Rate for Payer: Blue Shield of California EPN |
$180.35
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: InnovAge PACE Commercial |
$226.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$316.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Riverside University Health System MISP |
$180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$109.87
|
| Rate for Payer: Blue Shield of California EPN |
$71.86
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
IP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$333.50 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Cash Price |
$203.81
|
| Rate for Payer: Central Health Plan Commercial |
$296.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.11
|
| Rate for Payer: Multiplan Commercial |
$277.92
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
OP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$333.50 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.63
|
| Rate for Payer: Blue Shield of California Commercial |
$226.41
|
| Rate for Payer: Blue Shield of California EPN |
$147.85
|
| Rate for Payer: Cash Price |
$203.81
|
| Rate for Payer: Central Health Plan Commercial |
$296.45
|
| Rate for Payer: Cigna of CA HMO |
$237.16
|
| Rate for Payer: Cigna of CA PPO |
$274.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.50
|
| Rate for Payer: InnovAge PACE Commercial |
$185.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.39
|
| Rate for Payer: Multiplan Commercial |
$277.92
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
| Rate for Payer: Riverside University Health System MISP |
$148.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Other HMO |
$185.28
|
| Rate for Payer: United Healthcare HMO Rider |
$185.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.98
|
| Rate for Payer: Vantage Medical Group Senior |
$314.98
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
IP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Central Health Plan Commercial |
$103.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.89
|
| Rate for Payer: Multiplan Commercial |
$97.07
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
OP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.01
|
| Rate for Payer: Blue Shield of California Commercial |
$79.08
|
| Rate for Payer: Blue Shield of California EPN |
$51.64
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Central Health Plan Commercial |
$103.54
|
| Rate for Payer: Cigna of CA HMO |
$82.84
|
| Rate for Payer: Cigna of CA PPO |
$95.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.49
|
| Rate for Payer: InnovAge PACE Commercial |
$64.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.60
|
| Rate for Payer: Multiplan Commercial |
$97.07
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
| Rate for Payer: Riverside University Health System MISP |
$51.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.72
|
| Rate for Payer: United Healthcare All Other HMO |
$64.72
|
| Rate for Payer: United Healthcare HMO Rider |
$64.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.02
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Cash Price |
$774.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: EPIC Health Plan Senior |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$872.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.51
|
| Rate for Payer: Blue Shield of California Commercial |
$860.90
|
| Rate for Payer: Blue Shield of California EPN |
$562.19
|
| Rate for Payer: Cash Price |
$774.95
|
| Rate for Payer: Cash Price |
$774.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Cigna of CA HMO |
$901.76
|
| Rate for Payer: Cigna of CA PPO |
$1,042.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.50
|
| Rate for Payer: United Healthcare All Other HMO |
$704.50
|
| Rate for Payer: United Healthcare HMO Rider |
$704.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Cash Price |
$774.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: EPIC Health Plan Senior |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$872.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
