|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$419.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$546.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$702.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$562.65
|
| Rate for Payer: Cash Price |
$562.65
|
| Rate for Payer: Cash Price |
$562.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$664.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.24
|
| Rate for Payer: Heritage Provider Network Senior |
$633.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$487.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
| 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 |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$419.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$546.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$702.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$562.65
|
| Rate for Payer: Cash Price |
$562.65
|
| Rate for Payer: Cash Price |
$562.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$664.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.24
|
| Rate for Payer: Heritage Provider Network Senior |
$633.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$487.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
| 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 |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$185.16 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$204.60
|
| Rate for Payer: Cash Price |
$562.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.57
|
| Rate for Payer: Heritage Provider Network Senior |
$692.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Blue Shield of California Commercial |
$84.18
|
| Rate for Payer: Blue Shield of California EPN |
$67.34
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Senior |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$891.24 |
| Max. Negotiated Rate |
$3,693.00 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,333.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,333.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,382.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,200.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,954.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,047.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$891.24 |
| Max. Negotiated Rate |
$3,693.00 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,333.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,333.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,382.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Cash Price |
$2,708.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,200.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,954.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,047.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,348.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Senior |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Senior |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Senior |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85,890.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,762.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,767.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81,264.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$106,269.55
|
| Rate for Payer: Dignity Health Senior |
$106,269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77,389.24
|
| Rate for Payer: Heritage Provider Network Senior |
$77,389.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,635.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,516.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,516.10
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Senior |
$106,269.55
|
|
|
HC NEUROSTIM INSERT/REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0427T
|
| Hospital Charge Code |
906820306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22,629.16 |
| Max. Negotiated Rate |
$93,767.25 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$84,640.57
|
| Rate for Payer: Heritage Provider Network Senior |
$84,640.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
|
|
HC NEUROSTIM INSRT/REPL GEN, LEAD
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906820303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85,890.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,762.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,767.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81,264.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$106,269.55
|
| Rate for Payer: Dignity Health Senior |
$106,269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77,389.24
|
| Rate for Payer: Heritage Provider Network Senior |
$77,389.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,635.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,516.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,516.10
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Senior |
$106,269.55
|
|
|
HC NEUROSTIM INSRT/REPL GEN, LEAD
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906820303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22,629.16 |
| Max. Negotiated Rate |
$93,767.25 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$84,640.57
|
| Rate for Payer: Heritage Provider Network Senior |
$84,640.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
|
|
HC NEUROSTIM INSRT/REPL STIM LEAD
|
Facility
|
IP
|
$82,777.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,982.64 |
| Max. Negotiated Rate |
$62,082.75 |
| Rate for Payer: Adventist Health Commercial |
$16,555.40
|
| Rate for Payer: Cash Price |
$45,527.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$56,040.03
|
| Rate for Payer: Heritage Provider Network Senior |
$56,040.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,982.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,694.25
|
| Rate for Payer: Multiplan Commercial |
$62,082.75
|
|
|
HC NEUROSTIM INSRT/REPL STIM LEAD
|
Facility
|
OP
|
$82,777.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906820305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,531.00 |
| Max. Negotiated Rate |
$70,360.45 |
| Rate for Payer: Adventist Health Commercial |
$16,555.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,867.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70,360.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,527.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62,082.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$45,527.35
|
| Rate for Payer: Cash Price |
$45,527.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,805.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70,360.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$70,360.45
|
| Rate for Payer: Dignity Health Senior |
$70,360.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,238.96
|
| Rate for Payer: Heritage Provider Network Senior |
$51,238.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39,484.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,982.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,694.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57,943.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57,943.90
|
| Rate for Payer: Multiplan Commercial |
$62,082.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70,360.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70,360.45
|
| Rate for Payer: Vantage Medical Group Senior |
$70,360.45
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$13,379.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,286.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,786.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Senior |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,367.64
|
| Rate for Payer: Heritage Provider Network Senior |
$8,367.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,448.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL GEN
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906820307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$10,138.50 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,151.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,151.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
|
|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22,629.16 |
| Max. Negotiated Rate |
$93,767.25 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$84,640.57
|
| Rate for Payer: Heritage Provider Network Senior |
$84,640.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
|
|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$125,023.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85,890.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68,762.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93,767.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81,264.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$106,269.55
|
| Rate for Payer: Dignity Health Senior |
$106,269.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77,389.24
|
| Rate for Payer: Heritage Provider Network Senior |
$77,389.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59,635.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87,516.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,516.10
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106,269.55
|
| Rate for Payer: Vantage Medical Group Senior |
$106,269.55
|
|
