|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT MCAL
|
Facility
|
IP
|
$785.00
|
|
| Hospital Charge Code |
900413920
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$142.08 |
| Max. Negotiated Rate |
$588.75 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.30
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$531.44
|
| Rate for Payer: Heritage Provider Network Senior |
$531.44
|
| 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
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
905103307
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.00
|
| 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 |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.20
|
| Rate for Payer: Dignity Health Senior |
$78.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| 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 |
$78.20
|
| Rate for Payer: Vantage Medical Group Senior |
$78.20
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
905103307
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.20
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.28
|
| Rate for Payer: Heritage Provider Network Senior |
$62.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
900419041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
900419041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.75
|
| 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 |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.65
|
| Rate for Payer: Dignity Health Senior |
$75.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.09
|
| Rate for Payer: Heritage Provider Network Senior |
$55.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| 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 |
$75.65
|
| Rate for Payer: Vantage Medical Group Senior |
$75.65
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$118.00
|
|
| Hospital Charge Code |
905103306
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.50
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN
|
Facility
|
IP
|
$118.00
|
|
| Hospital Charge Code |
905103306
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
900419040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| 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 |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Dignity Health Senior |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.95
|
| Rate for Payer: Heritage Provider Network Senior |
$69.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| 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 |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
900419040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.63
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Senior |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
|
|
HC PHYS THER CASE CONSULT AND REPORT
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
905103308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| 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 |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Dignity Health Senior |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.95
|
| Rate for Payer: Heritage Provider Network Senior |
$69.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| 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 |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC PHYS THER CASE CONSULT AND REPORT
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
905103308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.63
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Senior |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
|
|
HC PHYS THER CASE CONSULT AND REPORT MCAL
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
900419042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| 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 |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Dignity Health Senior |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.95
|
| Rate for Payer: Heritage Provider Network Senior |
$69.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| 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 |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC PHYS THER CASE CONSULT AND REPORT MCAL
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
900419042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.63
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Senior |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Senior |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| 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 |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Senior |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| 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 |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
IP
|
$155.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.94
|
| Rate for Payer: Heritage Provider Network Senior |
$104.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
OP
|
$155.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.25
|
| 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 |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.75
|
| Rate for Payer: Dignity Health Senior |
$131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.94
|
| Rate for Payer: Heritage Provider Network Senior |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| 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 |
$131.75
|
| Rate for Payer: Vantage Medical Group Senior |
$131.75
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
IP
|
$227.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.68
|
| Rate for Payer: Heritage Provider Network Senior |
$153.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
OP
|
$227.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| 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 |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Senior |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| 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 |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.75
|
| 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 |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| 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 |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.22
|
| Rate for Payer: Heritage Provider Network Senior |
$276.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$148.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$136.31
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$253.37
|
| Rate for Payer: Blue Shield of California EPN |
$239.50
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Senior |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.90
|
| Rate for Payer: Heritage Provider Network Senior |
$188.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$204.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$148.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$136.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
