|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
IP
|
$5,609.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,015.23 |
| Max. Negotiated Rate |
$4,206.75 |
| Rate for Payer: Adventist Health Commercial |
$1,121.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,853.38
|
| Rate for Payer: Cash Price |
$2,524.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,797.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3,797.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,015.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,402.25
|
| Rate for Payer: Multiplan Commercial |
$4,206.75
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$5,609.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$214.75 |
| Max. Negotiated Rate |
$4,206.75 |
| Rate for Payer: Adventist Health Commercial |
$1,121.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,853.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Blue Shield of California Commercial |
$536.23
|
| Rate for Payer: Blue Shield of California EPN |
$304.94
|
| Rate for Payer: Cash Price |
$2,524.05
|
| Rate for Payer: Cash Price |
$2,524.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,645.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: Dignity Health Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,645.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$310.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,471.97
|
| Rate for Payer: Heritage Provider Network Senior |
$3,471.97
|
| Rate for Payer: Humana Medicare |
$310.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$590.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,015.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,402.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.66
|
| Rate for Payer: Multiplan Commercial |
$4,206.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$341.92
|
| Rate for Payer: TriValley Medical Group Senior |
$310.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: Dignity Health Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,047.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$310.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.21
|
| Rate for Payer: Heritage Provider Network Senior |
$997.21
|
| Rate for Payer: Humana Medicare |
$310.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$161.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$590.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.66
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$341.92
|
| Rate for Payer: TriValley Medical Group Senior |
$310.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$291.59 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.76
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$3,095.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$560.20 |
| Max. Negotiated Rate |
$2,321.25 |
| Rate for Payer: Adventist Health Commercial |
$619.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,126.26
|
| Rate for Payer: Cash Price |
$1,392.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,095.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,095.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.75
|
| Rate for Payer: Multiplan Commercial |
$2,321.25
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
OP
|
$3,095.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$132.15 |
| Max. Negotiated Rate |
$2,321.25 |
| Rate for Payer: Adventist Health Commercial |
$619.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,126.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$1,392.75
|
| Rate for Payer: Cash Price |
$1,392.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,011.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: Dignity Health Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,011.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$310.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,915.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,915.80
|
| Rate for Payer: Humana Medicare |
$310.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$590.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.66
|
| Rate for Payer: Multiplan Commercial |
$2,321.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$341.92
|
| Rate for Payer: TriValley Medical Group Senior |
$310.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
IP
|
$6,537.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$4,902.75 |
| Rate for Payer: Adventist Health Commercial |
$1,307.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,490.92
|
| Rate for Payer: Cash Price |
$2,941.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,425.55
|
| Rate for Payer: Heritage Provider Network Senior |
$4,425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,183.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,634.25
|
| Rate for Payer: Multiplan Commercial |
$4,902.75
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
OP
|
$6,537.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$204.09 |
| Max. Negotiated Rate |
$4,902.75 |
| Rate for Payer: Adventist Health Commercial |
$1,307.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$204.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,490.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Blue Shield of California Commercial |
$860.94
|
| Rate for Payer: Blue Shield of California EPN |
$489.59
|
| Rate for Payer: Cash Price |
$2,941.65
|
| Rate for Payer: Cash Price |
$2,941.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,249.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: Dignity Health Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,249.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$310.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,046.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4,046.40
|
| Rate for Payer: Humana Medicare |
$310.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$590.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,183.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,634.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.66
|
| Rate for Payer: Multiplan Commercial |
$4,902.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$341.92
|
| Rate for Payer: TriValley Medical Group Senior |
$310.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
IP
|
$4,993.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$3,744.75 |
| Rate for Payer: Adventist Health Commercial |
$998.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,430.19
|
| Rate for Payer: Cash Price |
$2,246.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,380.26
|
| Rate for Payer: Heritage Provider Network Senior |
$3,380.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.25
|
| Rate for Payer: Multiplan Commercial |
$3,744.75
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
OP
|
$4,993.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$241.64 |
| Max. Negotiated Rate |
$3,744.75 |
| Rate for Payer: Adventist Health Commercial |
$998.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$633.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,430.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,130.47
|
| Rate for Payer: Blue Shield of California EPN |
$642.86
|
| Rate for Payer: Cash Price |
$2,246.85
|
| Rate for Payer: Cash Price |
$2,246.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,245.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,245.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,090.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,090.67
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$3,744.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| 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 |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA PT
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905103406
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.34
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA PT
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900419061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA PT
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900419061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| 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 |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA PT
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905103406
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Senior |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.94
|
| Rate for Payer: Heritage Provider Network Senior |
$121.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| 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 |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC RANGE OF MOTION MEAS HAND
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905104407
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION MEAS HAND
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900419062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| 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 |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION MEAS HAND
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905103407
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Senior |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.94
|
| Rate for Payer: Heritage Provider Network Senior |
$121.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| 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 |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC RANGE OF MOTION MEAS HAND
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900419062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION MEAS HAND
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905103407
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.34
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
|
|
HC RANGE OF MOTION MEAS HAND
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905104407
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| 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 |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| 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 |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
