|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
IP
|
$72,520.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906810427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,504.00 |
| Max. Negotiated Rate |
$61,642.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,370.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,630.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,889.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
OP
|
$72,520.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906810427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,886.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54,390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Cigna of CA HMO |
$46,412.80
|
| Rate for Payer: Cigna of CA PPO |
$53,664.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,642.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,642.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,370.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,630.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,889.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,764.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,764.00
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,512.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,642.00
|
|
|
HC NEUROSTIM INSRT/REPL GEN, LEAD
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906820303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,004.60 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
|
|
HC NEUROSTIM INSRT/REPL GEN, LEAD
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906820303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$109,559.00 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,762.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,767.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cigna of CA HMO |
$80,014.72
|
| Rate for Payer: Cigna of CA PPO |
$92,517.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$106,269.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106,269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,516.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,516.10
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75,013.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Senior |
$106,269.55
|
|
|
HC NEUROSTIM INSRT/REPL STIM LEAD
|
Facility
|
OP
|
$82,777.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$70,360.45 |
| Rate for Payer: Adventist Health Commercial |
$16,555.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70,360.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,527.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62,082.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$37,249.65
|
| Rate for Payer: Cash Price |
$37,249.65
|
| Rate for Payer: Cigna of CA HMO |
$52,977.28
|
| Rate for Payer: Cigna of CA PPO |
$61,254.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70,360.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$70,360.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70,360.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$33,110.80
|
| Rate for Payer: Galaxy Health WC |
$70,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$49,666.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55,212.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,538.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,238.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,866.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57,943.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57,943.90
|
| Rate for Payer: Multiplan Commercial |
$66,221.60
|
| Rate for Payer: Networks By Design Commercial |
$53,805.05
|
| Rate for Payer: Prime Health Services Commercial |
$70,360.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49,666.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70,360.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70,360.45
|
| Rate for Payer: Vantage Medical Group Senior |
$70,360.45
|
|
|
HC NEUROSTIM INSRT/REPL STIM LEAD
|
Facility
|
IP
|
$82,777.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16,555.40 |
| Max. Negotiated Rate |
$70,360.45 |
| Rate for Payer: Adventist Health Commercial |
$16,555.40
|
| Rate for Payer: Cash Price |
$37,249.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$33,110.80
|
| Rate for Payer: Galaxy Health WC |
$70,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$49,666.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55,212.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,538.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,238.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,866.48
|
| Rate for Payer: Multiplan Commercial |
$66,221.60
|
| Rate for Payer: Networks By Design Commercial |
$53,805.05
|
| Rate for Payer: Prime Health Services Commercial |
$70,360.45
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,004.60 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
|
|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,762.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,767.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,618.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cigna of CA HMO |
$80,014.72
|
| Rate for Payer: Cigna of CA PPO |
$92,517.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$106,269.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106,269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,516.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,516.10
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75,013.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Senior |
$106,269.55
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
OP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.34
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
IP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.51
|
| Rate for Payer: Blue Shield of California Commercial |
$195.84
|
| Rate for Payer: Blue Shield of California EPN |
$129.28
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.34
|
| 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 HMO/PPO |
$113.61
|
| Rate for Payer: Blue Shield of California Commercial |
$113.22
|
| Rate for Payer: Blue Shield of California EPN |
$74.74
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| 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 |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| 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 NEWBORN HEARING SCREENING OP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.34
|
| 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 HMO/PPO |
$113.61
|
| Rate for Payer: Blue Shield of California Commercial |
$113.22
|
| Rate for Payer: Blue Shield of California EPN |
$74.74
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| 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 |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| 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
|
|
