|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.24
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.81
|
| Rate for Payer: Heritage Provider Network Senior |
$96.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$88.80
|
| Rate for Payer: Blue Shield of California EPN |
$83.94
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.52
|
| Rate for Payer: Heritage Provider Network Senior |
$88.52
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.24
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.81
|
| Rate for Payer: Heritage Provider Network Senior |
$96.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Blue Shield of California Commercial |
$88.80
|
| Rate for Payer: Blue Shield of California EPN |
$83.94
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.52
|
| Rate for Payer: Heritage Provider Network Senior |
$88.52
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.25
|
| 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 |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.75
|
| Rate for Payer: Dignity Health Senior |
$80.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| 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 |
$80.75
|
| Rate for Payer: Vantage Medical Group Senior |
$80.75
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.32
|
| Rate for Payer: Heritage Provider Network Senior |
$64.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.25
|
| 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 |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.75
|
| Rate for Payer: Dignity Health Senior |
$80.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| 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 |
$80.75
|
| Rate for Payer: Vantage Medical Group Senior |
$80.75
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.32
|
| Rate for Payer: Heritage Provider Network Senior |
$64.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| 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 |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| 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 |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.25
|
| 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 |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.75
|
| Rate for Payer: Dignity Health Senior |
$80.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| 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 |
$80.75
|
| Rate for Payer: Vantage Medical Group Senior |
$80.75
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.32
|
| Rate for Payer: Heritage Provider Network Senior |
$64.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$180.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$620.36
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906820000
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$180.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$620.36
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906820000
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$7,340.00 |
| Rate for Payer: Adventist Health Commercial |
$180.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$378.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$620.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$767.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$496.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$677.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$767.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$767.55
|
| Rate for Payer: Dignity Health Senior |
$767.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.96
|
| Rate for Payer: Heritage Provider Network Senior |
$558.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$767.55
|
| Rate for Payer: Vantage Medical Group Senior |
$767.55
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$7,340.00 |
| Rate for Payer: Adventist Health Commercial |
$180.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$378.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$620.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$767.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$496.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$677.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cash Price |
$406.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$767.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$767.55
|
| Rate for Payer: Dignity Health Senior |
$767.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.96
|
| Rate for Payer: Heritage Provider Network Senior |
$558.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$767.55
|
| Rate for Payer: Vantage Medical Group Senior |
$767.55
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN
|
Facility
|
OP
|
$127.00
|
|
| Hospital Charge Code |
905103310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.25
|
| 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 |
$57.15
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.95
|
| Rate for Payer: Dignity Health Senior |
$107.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.61
|
| Rate for Payer: Heritage Provider Network Senior |
$78.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.21
|
| 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
|
| 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 |
$107.95
|
| Rate for Payer: Vantage Medical Group Senior |
$107.95
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN
|
Facility
|
IP
|
$127.00
|
|
| Hospital Charge Code |
905103310
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN MCAL
|
Facility
|
IP
|
$127.00
|
|
| Hospital Charge Code |
900413922
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN MCAL
|
Facility
|
OP
|
$127.00
|
|
| Hospital Charge Code |
900413922
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.25
|
| 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 |
$57.15
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.95
|
| Rate for Payer: Dignity Health Senior |
$107.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.61
|
| Rate for Payer: Heritage Provider Network Senior |
$78.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.21
|
| 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
|
| 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 |
$107.95
|
| Rate for Payer: Vantage Medical Group Senior |
$107.95
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
905103309
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
905103309
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| 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 |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT MCAL
|
Facility
|
OP
|
$785.00
|
|
| Hospital Charge Code |
900413920
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$667.25 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$419.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$667.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$588.75
|
| 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 |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$510.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$667.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$667.25
|
| Rate for Payer: Dignity Health Senior |
$667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$485.92
|
| Rate for Payer: Heritage Provider Network Senior |
$485.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$378.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.25
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$667.25
|
| Rate for Payer: Vantage Medical Group Senior |
$667.25
|
|
