|
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 |
$698.35 |
| Max. Negotiated Rate |
$3,024.00 |
| Rate for Payer: Adventist Health Commercial |
$806.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,491.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,016.81
|
| 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 |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,620.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| 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) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,923.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$3,024.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| 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 |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
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: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| 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 |
$150.09
|
| 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 |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| 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 Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| 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) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| 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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
905103406
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
905103407
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$35.66 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| 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 |
$347.00
|
| 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 |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 RBC ANTIBODY ADSORPTION
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$242.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.86
|
| Rate for Payer: Blue Shield of California Commercial |
$105.02
|
| Rate for Payer: Blue Shield of California EPN |
$84.46
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$186.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.87
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.45
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
|
