|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$104.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.02
|
| Rate for Payer: InnovAge PACE Commercial |
$127.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Riverside University Health System MISP |
$101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$104.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.02
|
| Rate for Payer: InnovAge PACE Commercial |
$127.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Riverside University Health System MISP |
$101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Adventist Health Commercial |
$103.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Central Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.40
|
| Rate for Payer: EPIC Health Plan Senior |
$206.40
|
| Rate for Payer: Galaxy Health WC |
$438.60
|
| Rate for Payer: Global Benefits Group Commercial |
$309.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$319.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$387.00
|
| Rate for Payer: Networks By Design Commercial |
$335.40
|
| Rate for Payer: Prime Health Services Commercial |
$438.60
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$103.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.37
|
| 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 |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.05
|
| Rate for Payer: Blue Shield of California Commercial |
$313.21
|
| Rate for Payer: Blue Shield of California EPN |
$204.85
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Central Health Plan Commercial |
$412.80
|
| Rate for Payer: Cigna of CA HMO |
$330.24
|
| Rate for Payer: Cigna of CA PPO |
$381.84
|
| 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 |
$438.60
|
| Rate for Payer: Global Benefits Group Commercial |
$309.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$464.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.34
|
| 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 |
$344.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| 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 |
$387.00
|
| Rate for Payer: Networks By Design Commercial |
$335.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$438.60
|
| 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 |
$309.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.60
|
| 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 NEUROSTIM INSERT/REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,004.60 |
| Max. Negotiated Rate |
$112,520.70 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Central Health Plan Commercial |
$100,018.40
|
| 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: Health Management Network EPO/PPO |
$112,520.70
|
| 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 |
$25,004.60
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
OP
|
$143,776.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906810427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79,076.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107,832.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69,616.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: Cigna of CA HMO |
$92,016.64
|
| Rate for Payer: Cigna of CA PPO |
$106,394.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$122,209.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122,209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: InnovAge PACE Commercial |
$71,888.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95,898.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,778.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88,997.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100,643.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,643.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
| Rate for Payer: Riverside University Health System MISP |
$57,510.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86,265.60
|
| 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 |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Senior |
$122,209.60
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$112,520.70 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$60,536.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Central Health Plan Commercial |
$100,018.40
|
| 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: Health Management Network EPO/PPO |
$112,520.70
|
| Rate for Payer: InnovAge PACE Commercial |
$62,511.50
|
| 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 |
$25,004.60
|
| 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 |
$93,767.25
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
| Rate for Payer: Riverside University Health System MISP |
$50,009.20
|
| 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 INSERT/REPL GEN
|
Facility
|
IP
|
$143,776.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906810427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28,755.20 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Cash Price |
$64,699.20
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95,898.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,778.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88,997.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
|
|
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 |
$112,520.70 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Central Health Plan Commercial |
$100,018.40
|
| 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: Health Management Network EPO/PPO |
$112,520.70
|
| 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 |
$25,004.60
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
| 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 |
$5,113.68 |
| Max. Negotiated Rate |
$112,520.70 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$60,536.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Central Health Plan Commercial |
$100,018.40
|
| 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: Health Management Network EPO/PPO |
$112,520.70
|
| Rate for Payer: InnovAge PACE Commercial |
$62,511.50
|
| 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 |
$25,004.60
|
| 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 |
$93,767.25
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
| Rate for Payer: Riverside University Health System MISP |
$50,009.20
|
| 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 |
$5,113.68 |
| Max. Negotiated Rate |
$74,499.30 |
| Rate for Payer: Adventist Health Commercial |
$16,555.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$40,080.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48,614.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$37,249.65
|
| Rate for Payer: Cash Price |
$37,249.65
|
| Rate for Payer: Central Health Plan Commercial |
$66,221.60
|
| 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: Health Management Network EPO/PPO |
$74,499.30
|
| Rate for Payer: InnovAge PACE Commercial |
$41,388.50
|
| 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 |
$16,555.40
|
| 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 |
$62,082.75
|
| Rate for Payer: Networks By Design Commercial |
$53,805.05
|
| Rate for Payer: Prime Health Services Commercial |
$70,360.45
|
| Rate for Payer: Riverside University Health System MISP |
$33,110.80
|
| 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 |
$74,499.30 |
| Rate for Payer: Adventist Health Commercial |
$16,555.40
|
| Rate for Payer: Cash Price |
$37,249.65
|
| Rate for Payer: Central Health Plan Commercial |
$66,221.60
|
| 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: Health Management Network EPO/PPO |
$74,499.30
|
| 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 |
$16,555.40
|
| Rate for Payer: Multiplan Commercial |
$62,082.75
|
| 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 |
$12,166.20 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| 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 |
$2,703.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| 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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$6,545.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| Rate for Payer: InnovAge PACE Commercial |
$6,759.00
|
| 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 |
$2,703.60
|
| 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 |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Riverside University Health System MISP |
$5,407.20
|
| 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 |
$112,520.70 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Central Health Plan Commercial |
$100,018.40
|
| 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: Health Management Network EPO/PPO |
$112,520.70
|
| 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 |
$25,004.60
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
| 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 |
$5,113.68 |
| Max. Negotiated Rate |
$112,520.70 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$60,536.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Central Health Plan Commercial |
$100,018.40
|
| 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: Health Management Network EPO/PPO |
$112,520.70
|
| Rate for Payer: InnovAge PACE Commercial |
$62,511.50
|
| 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 |
$25,004.60
|
| 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 |
$93,767.25
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
| Rate for Payer: Riverside University Health System MISP |
$50,009.20
|
| 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
|
$15,546.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,527.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,130.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: InnovAge PACE Commercial |
$7,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,882.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| 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 |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
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 |
$12,166.20 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| 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 |
$2,703.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$6,545.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,939.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| Rate for Payer: InnovAge PACE Commercial |
$6,759.00
|
| 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 |
$2,703.60
|
| 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 |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Riverside University Health System MISP |
$5,407.20
|
| 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
|
$15,546.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$6,545.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,939.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| Rate for Payer: InnovAge PACE Commercial |
$6,759.00
|
| 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 |
$2,703.60
|
| 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 |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Riverside University Health System MISP |
$5,407.20
|
| 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 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 |
$12,166.20 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| 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 |
$2,703.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$12,166.20 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| 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: Health Management Network EPO/PPO |
$12,166.20
|
| 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 |
$2,703.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
