|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| 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 PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| 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 |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| 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: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
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: Cash Price |
$41.80
|
| 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 PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| 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 |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| 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: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| 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 |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| 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: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
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: Cash Price |
$41.80
|
| 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 PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906820000
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cash Price |
$570.90
|
| 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 |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 |
$159.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.50
|
| Rate for Payer: Multiplan Commercial |
$661.50
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906820000
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$554.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$882.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$570.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$778.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$882.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.30
|
| Rate for Payer: Dignity Health Senior |
$882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$642.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$495.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$726.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$726.60
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$882.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.30
|
| Rate for Payer: Vantage Medical Group Senior |
$882.30
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$471.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.70
|
| Rate for Payer: Dignity Health Senior |
$749.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.96
|
| Rate for Payer: Heritage Provider Network Senior |
$545.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$420.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.40
|
| Rate for Payer: Multiplan Commercial |
$661.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.70
|
| Rate for Payer: Vantage Medical Group Senior |
$749.70
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
905103310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Senior |
$111.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.09
|
| Rate for Payer: Heritage Provider Network Senior |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
905103310
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$98.25 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.69
|
| Rate for Payer: Heritage Provider Network Senior |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.75
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN MCAL
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
900413922
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Senior |
$111.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.09
|
| Rate for Payer: Heritage Provider Network Senior |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC PHYS THER ANY TEST/MEASURE ADDL 15 MIN MCAL
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
900413922
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$98.25 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.69
|
| Rate for Payer: Heritage Provider Network Senior |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.75
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT
|
Facility
|
IP
|
$309.00
|
|
| Hospital Charge Code |
905103309
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.93 |
| Max. Negotiated Rate |
$231.75 |
| Rate for Payer: Adventist Health Commercial |
$61.80
|
| Rate for Payer: Cash Price |
$169.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.19
|
| Rate for Payer: Heritage Provider Network Senior |
$209.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.25
|
| Rate for Payer: Multiplan Commercial |
$231.75
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT
|
Facility
|
OP
|
$309.00
|
|
| Hospital Charge Code |
905103309
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.93 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$126.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$212.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$169.95
|
| Rate for Payer: Cash Price |
$169.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.65
|
| Rate for Payer: Dignity Health Senior |
$262.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.27
|
| Rate for Payer: Heritage Provider Network Senior |
$191.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$216.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$216.30
|
| Rate for Payer: Multiplan Commercial |
$231.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.65
|
| Rate for Payer: Vantage Medical Group Senior |
$262.65
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT MCAL
|
Facility
|
OP
|
$809.00
|
|
| Hospital Charge Code |
900413920
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$331.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$687.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$525.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$687.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$687.65
|
| Rate for Payer: Dignity Health Senior |
$687.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$525.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.77
|
| Rate for Payer: Heritage Provider Network Senior |
$500.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$566.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$566.30
|
| Rate for Payer: Multiplan Commercial |
$606.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$687.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$687.65
|
| Rate for Payer: Vantage Medical Group Senior |
$687.65
|
|
|
HC PHYS THER ANY TEST/MEASURE INIT 30 MIN PT MCAL
|
Facility
|
IP
|
$809.00
|
|
| Hospital Charge Code |
900413920
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$146.43 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.69
|
| Rate for Payer: Heritage Provider Network Senior |
$547.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.25
|
| Rate for Payer: Multiplan Commercial |
$606.75
|
|
|
HC PHYS THER APP OF SURFACE NEUROSTIMULATOR
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
905103350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PHYS THER APP OF SURFACE NEUROSTIMULATOR
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
905103350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC PHYS THER APP OF SURFACE NEUROSTIMULATOR COMM MCARE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
900419074
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PHYS THER APP OF SURFACE NEUROSTIMULATOR COMM MCARE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
900419074
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
905103307
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$40.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Senior |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
905103307
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC PHYS THER CASE CONF EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
900419041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
