|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
IP
|
$8,646.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,564.93 |
| Max. Negotiated Rate |
$6,484.50 |
| Rate for Payer: Adventist Health Commercial |
$1,729.20
|
| Rate for Payer: Cash Price |
$4,755.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,853.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,853.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,564.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.50
|
| Rate for Payer: Multiplan Commercial |
$6,484.50
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
IP
|
$4,032.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$729.79 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Adventist Health Commercial |
$806.40
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,729.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,729.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$3,024.00
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
OP
|
$4,032.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$250.94 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Adventist Health Commercial |
$806.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,155.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,769.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,164.43
|
| Rate for Payer: Blue Shield of California EPN |
$936.40
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,620.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,495.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,495.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,923.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$3,024.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,016.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,016.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC RAGWEED WESTERN IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| 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 |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| 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 |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| 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 |
$49.50
|
| 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
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
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: Cash Price |
$108.35
|
| 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 MCAL
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
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: Cash Price |
$108.35
|
| 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
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900419061
|
|
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: Cash Price |
$108.35
|
| 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
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905103406
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA PT
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900419061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| 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
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905103407
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| 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
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905104407
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| 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
|
$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: Cash Price |
$108.35
|
| 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
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
905104407
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$108.35
|
| 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
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900419062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| 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
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900419062
|
|
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: Cash Price |
$108.35
|
| 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 MCAL
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 MCAL
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
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: Cash Price |
$108.35
|
| 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 MCAL
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| 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 MCAL
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 LIMB TRUNK OT
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 LIMB TRUNK OT
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.30
|
| 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 |
$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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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 |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
