|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$224.24 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,562.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,416.80
|
| Rate for Payer: Cigna of CA PPO |
$3,160.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$3,630.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,562.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,843.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,203.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,848.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$854.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$3,203.25
|
| Rate for Payer: Networks By Design Commercial |
$2,776.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,630.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,562.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.15
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Riverside University Health System MISP |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.15
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Riverside University Health System MISP |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$189.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Central Health Plan Commercial |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Media |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.15
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Riverside University Health System MISP |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.00
|
| Rate for Payer: Blue Distinction Transplant |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$268.83
|
| Rate for Payer: Blue Shield of California EPN |
$211.41
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$326.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
OP
|
$108,716.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,023.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59,793.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,793.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$65,229.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: Cigna of CA PPO |
$80,449.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Media |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$81,537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,050.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
| Rate for Payer: Riverside University Health System MISP |
$43,486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65,229.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92,408.60
|
| Rate for Payer: Vantage Medical Group Senior |
$92,408.60
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
IP
|
$108,716.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,743.20 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
|
|
HC NEUROSTIM INSRT/REPL GEN, LEAD
|
Facility
|
OP
|
$108,716.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906820303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,023.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59,793.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,793.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$65,229.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: Cigna of CA PPO |
$80,449.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Media |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$81,537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,050.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
| Rate for Payer: Riverside University Health System MISP |
$43,486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65,229.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92,408.60
|
| Rate for Payer: Vantage Medical Group Senior |
$92,408.60
|
|
|
HC NEUROSTIM INSRT/REPL GEN, LEAD
|
Facility
|
IP
|
$108,716.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906820303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,743.20 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
|
|
HC NEUROSTIM INSRT/REPL STIM LEAD
|
Facility
|
IP
|
$71,980.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,396.00 |
| Max. Negotiated Rate |
$64,782.00 |
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Central Health Plan Commercial |
$57,584.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,792.00
|
| Rate for Payer: Galaxy Health WC |
$61,183.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$64,782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,010.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,424.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,396.00
|
| Rate for Payer: Multiplan Commercial |
$53,985.00
|
| Rate for Payer: Networks By Design Commercial |
$46,787.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,183.00
|
|
|
HC NEUROSTIM INSRT/REPL STIM LEAD
|
Facility
|
OP
|
$71,980.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,974.00 |
| Max. Negotiated Rate |
$64,782.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,713.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,183.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,589.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,589.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$43,188.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Central Health Plan Commercial |
$57,584.00
|
| Rate for Payer: Cigna of CA PPO |
$53,265.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,183.00
|
| Rate for Payer: Dignity Health Media |
$61,183.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,792.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28,792.00
|
| Rate for Payer: Galaxy Health WC |
$61,183.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$64,782.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53,985.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,193.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,010.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,424.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,396.00
|
| Rate for Payer: Multiplan Commercial |
$53,985.00
|
| Rate for Payer: Networks By Design Commercial |
$46,787.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,183.00
|
| Rate for Payer: Riverside University Health System MISP |
$28,792.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,188.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,183.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,183.00
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$108,716.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,023.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59,793.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,793.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$65,229.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: Cigna of CA PPO |
$80,449.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Media |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$81,537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,050.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
| Rate for Payer: Riverside University Health System MISP |
$43,486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65,229.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92,408.60
|
| Rate for Payer: Vantage Medical Group Senior |
$92,408.60
|
|
|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$108,716.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,743.20 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
