|
HC PHYS THER CASE CONF EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
900419041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| 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 |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Senior |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.84
|
| 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: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| 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 |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
905103306
|
|
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: Cash Price |
$68.75
|
| 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 CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
905103306
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$51.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.81
|
| 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 |
$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 |
$68.75
|
| Rate for Payer: Cash Price |
$68.75
|
| 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 |
$59.62
|
| 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: Molina Healthcare of CA Medi-Cal |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
900419040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| 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 |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| 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 |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC PHYS THER CASE CONF INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
900419040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC PHYS THER CASE CONSULT AND REPORT
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
905103308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| 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 |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| 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 |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC PHYS THER CASE CONSULT AND REPORT
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
905103308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC PHYS THER CASE CONSULT AND REPORT MCAL
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
900419042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC PHYS THER CASE CONSULT AND REPORT MCAL
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
900419042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| 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 |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| 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 |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| 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 |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Senior |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| 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 |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| 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 |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Senior |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| 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 |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| 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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Senior |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| 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 |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
OP
|
$234.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$95.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.50
|
| 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 |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.90
|
| Rate for Payer: Dignity Health Senior |
$198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.85
|
| Rate for Payer: Heritage Provider Network Senior |
$144.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| 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 |
$198.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.90
|
| Rate for Payer: Vantage Medical Group Senior |
$198.90
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
IP
|
$234.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.42
|
| Rate for Payer: Heritage Provider Network Senior |
$158.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| 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 |
$91.30
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Senior |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| 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 |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$164.02
|
| Rate for Payer: Blue Shield of California EPN |
$164.02
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| 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 |
$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 |
$147.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.09
|
|
|
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 |
$13,240.00 |
| 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 |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$164.02
|
| Rate for Payer: Blue Shield of California EPN |
$164.02
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| 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: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$121.40
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.83
|
| Rate for Payer: Heritage Provider Network Senior |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.99
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$121.40
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: Cash Price |
$166.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.70
|
| Rate for Payer: Dignity Health Senior |
$256.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.83
|
| Rate for Payer: Heritage Provider Network Senior |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.70
|
| Rate for Payer: Vantage Medical Group Senior |
$256.70
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,581.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,442.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,325.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
|
