|
HC ELECT STIM MANUAL 15 MIN PT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
905103122
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC ELECT STIM MANUAL 15 MIN PT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900417032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC ELECT STIM MANUAL 15 MIN PT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
900417032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC ELECT STIM MANUAL 15 MIN PT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
905103122
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC ELECT STIM MANUAL 15 MIN ST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
905601303
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC ELECT STIM MANUAL 15 MIN ST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
905601303
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC ELECT STIM MANUAL 15 MIN ST MCAL
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
907000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC ELECT STIM MANUAL 30 MIN PT
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
905103193
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.52
|
| Rate for Payer: Heritage Provider Network Senior |
$75.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC ELECT STIM MANUAL 30 MIN PT
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
905103193
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.57
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$96.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$153.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.08
|
| Rate for Payer: Heritage Provider Network Senior |
$146.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$112.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC ELECT STIM OTHER THAN WOUND CA MCAL
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900400046
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.98
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.77
|
| Rate for Payer: Heritage Provider Network Senior |
$159.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
|
|
HC ELECT STIM OTHER THAN WOUND CA PT
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905103509
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.23
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
HC ELECT STIM OTHER THAN WOUND CA PT
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905103509
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$134.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$278.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$278.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$156.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$278.80
|
| Rate for Payer: Vantage Medical Group Senior |
$278.80
|
|
|
HC ELECT STIM OTHER THAN WOUND CA PT COMM MCARE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900419079
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.42
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.18
|
| Rate for Payer: Heritage Provider Network Senior |
$77.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
|
|
HC ELECT STIM OTHER THAN WOUND CA PT COMM MCARE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
900419079
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$46.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.57
|
| Rate for Payer: Heritage Provider Network Senior |
$70.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.23
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$134.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$278.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$278.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$156.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$278.80
|
| Rate for Payer: Vantage Medical Group Senior |
$278.80
|
|
|
HC ELECT STIMULATION UNATTENDED OT
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905104105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$134.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$278.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$278.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$156.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$278.80
|
| Rate for Payer: Vantage Medical Group Senior |
$278.80
|
|
|
HC ELECT STIMULATION UNATTENDED OT
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905104105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.23
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
HC ELECT STIMULATION UNATTENDED PT
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905103105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.81 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.99
|
| Rate for Payer: Heritage Provider Network Senior |
$142.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$110.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC ELECT STIMULATION UNATTENDED PT
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905103105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.81 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.76
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.39
|
| Rate for Payer: Heritage Provider Network Senior |
$156.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.47
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.67
|
| Rate for Payer: Heritage Provider Network Senior |
$65.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.47
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.67
|
| Rate for Payer: Heritage Provider Network Senior |
$65.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
|
