|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.95
|
| Rate for Payer: Dignity Health Senior |
$141.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.95
|
| Rate for Payer: Vantage Medical Group Senior |
$141.95
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.06
|
| Rate for Payer: Heritage Provider Network Senior |
$113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.06
|
| Rate for Payer: Heritage Provider Network Senior |
$113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.95
|
| Rate for Payer: Dignity Health Senior |
$141.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.95
|
| Rate for Payer: Vantage Medical Group Senior |
$141.95
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.06
|
| Rate for Payer: Heritage Provider Network Senior |
$113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.95
|
| Rate for Payer: Dignity Health Senior |
$141.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.95
|
| Rate for Payer: Vantage Medical Group Senior |
$141.95
|
|
|
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 |
$19,677.60 |
| Max. Negotiated Rate |
$81,537.00 |
| Rate for Payer: Adventist Health Commercial |
$21,743.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74,687.89
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$73,600.73
|
| Rate for Payer: Heritage Provider Network Senior |
$73,600.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,677.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,179.00
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
|
|
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 |
$7,468.44 |
| Max. Negotiated Rate |
$92,408.60 |
| Rate for Payer: Adventist Health Commercial |
$21,743.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74,687.89
|
| 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 |
$81,537.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70,665.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: Dignity Health Senior |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67,295.20
|
| Rate for Payer: Heritage Provider Network Senior |
$67,295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52,401.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,677.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,179.00
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| 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 |
$19,677.60 |
| Max. Negotiated Rate |
$81,537.00 |
| Rate for Payer: Adventist Health Commercial |
$21,743.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74,687.89
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$73,600.73
|
| Rate for Payer: Heritage Provider Network Senior |
$73,600.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,677.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,179.00
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
|
|
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 |
$7,468.44 |
| Max. Negotiated Rate |
$92,408.60 |
| Rate for Payer: Adventist Health Commercial |
$21,743.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74,687.89
|
| 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 |
$81,537.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70,665.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: Dignity Health Senior |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67,295.20
|
| Rate for Payer: Heritage Provider Network Senior |
$67,295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52,401.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,677.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,179.00
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| 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 STIM LEAD
|
Facility
|
OP
|
$71,980.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,237.00 |
| Max. Negotiated Rate |
$61,183.00 |
| Rate for Payer: Adventist Health Commercial |
$14,396.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,450.26
|
| 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 |
$53,985.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cigna of CA HMO/PPO |
$46,787.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,183.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,183.00
|
| Rate for Payer: Dignity Health Senior |
$61,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$44,555.62
|
| Rate for Payer: Heritage Provider Network Senior |
$44,555.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34,694.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,028.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,995.00
|
| Rate for Payer: Multiplan Commercial |
$53,985.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,183.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,183.00
|
|
|
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 |
$13,028.38 |
| Max. Negotiated Rate |
$53,985.00 |
| Rate for Payer: Adventist Health Commercial |
$14,396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,450.26
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,730.46
|
| Rate for Payer: Heritage Provider Network Senior |
$48,730.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,028.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,995.00
|
| Rate for Payer: Multiplan Commercial |
$53,985.00
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,127.66 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| 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 |
$8,816.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,640.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: Dignity Health Senior |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,276.34
|
| Rate for Payer: Heritage Provider Network Senior |
$7,276.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,665.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 |
$2,127.66 |
| Max. Negotiated Rate |
$8,816.25 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,958.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,958.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
|
|
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 |
$19,677.60 |
| Max. Negotiated Rate |
$81,537.00 |
| Rate for Payer: Adventist Health Commercial |
$21,743.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74,687.89
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$73,600.73
|
| Rate for Payer: Heritage Provider Network Senior |
$73,600.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,677.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,179.00
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
|
|
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 |
$7,468.44 |
| Max. Negotiated Rate |
$92,408.60 |
| Rate for Payer: Adventist Health Commercial |
$21,743.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74,687.89
|
| 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 |
$81,537.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,266.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70,665.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: Dignity Health Senior |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67,295.20
|
| Rate for Payer: Heritage Provider Network Senior |
$67,295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52,401.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,677.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,179.00
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92,408.60
|
| Rate for Payer: Vantage Medical Group Senior |
$92,408.60
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,127.66 |
| Max. Negotiated Rate |
$8,816.25 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,958.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,958.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
|
|
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 |
$2,127.66 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| 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 |
$8,816.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cigna of CA HMO/PPO |
$7,640.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: Dignity Health Senior |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,276.34
|
| Rate for Payer: Heritage Provider Network Senior |
$7,276.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,665.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 |
$2,127.66 |
| Max. Negotiated Rate |
$8,816.25 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,958.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,958.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
|
|
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 |
$2,127.66 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| 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 |
$8,816.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cigna of CA HMO/PPO |
$7,640.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: Dignity Health Senior |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,276.34
|
| Rate for Payer: Heritage Provider Network Senior |
$7,276.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,665.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,127.66 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| 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 |
$8,816.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| 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: Cigna of CA HMO/PPO |
$7,640.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: Dignity Health Senior |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,276.34
|
| Rate for Payer: Heritage Provider Network Senior |
$7,276.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,665.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 |
$2,127.66 |
| Max. Negotiated Rate |
$8,816.25 |
| Rate for Payer: Adventist Health Commercial |
$2,351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,075.68
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,958.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,958.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,938.75
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$91.90
|
| Rate for Payer: Blue Shield of California EPN |
$52.26
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.61
|
| Rate for Payer: Heritage Provider Network Senior |
$130.61
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.96
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.85
|
| Rate for Payer: Heritage Provider Network Senior |
$142.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.25
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.98
|
| Rate for Payer: Heritage Provider Network Senior |
$85.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
|
