|
HC THERAPEUTIC PROCEDURE 15 MIN MCAL
|
Facility
OP
|
$299.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
907000036
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$164.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$224.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$194.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$254.15
|
| Rate for Payer: Dignity Health Senior |
$254.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.08
|
| Rate for Payer: Heritage Provider Network Senior |
$185.08
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$254.15
|
| Rate for Payer: Vantage Medical Group Senior |
$254.15
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN OT
|
Facility
IP
|
$203.00
|
|
| Hospital Charge Code |
901309044
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$152.25 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.46
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.43
|
| Rate for Payer: Heritage Provider Network Senior |
$137.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.75
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN OT
|
Facility
OP
|
$203.00
|
|
| Hospital Charge Code |
901309044
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$108.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.55
|
| Rate for Payer: Dignity Health Senior |
$172.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.66
|
| Rate for Payer: Heritage Provider Network Senior |
$125.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.75
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.55
|
| Rate for Payer: Vantage Medical Group Senior |
$172.55
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410478
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905103225
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905103225
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410478
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN ST
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905601304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN ST
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905601304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$126.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.65
|
| Rate for Payer: Dignity Health Senior |
$143.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.61
|
| Rate for Payer: Heritage Provider Network Senior |
$104.61
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
OP
|
$203.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$108.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.55
|
| Rate for Payer: Dignity Health Senior |
$172.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.66
|
| Rate for Payer: Heritage Provider Network Senior |
$125.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.75
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.55
|
| Rate for Payer: Vantage Medical Group Senior |
$172.55
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
IP
|
$203.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$152.25 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.46
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.43
|
| Rate for Payer: Heritage Provider Network Senior |
$137.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.75
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104139
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$366.35 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$366.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$237.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$323.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$366.35
|
| Rate for Payer: Dignity Health Senior |
$366.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.79
|
| Rate for Payer: Heritage Provider Network Senior |
$266.79
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.75
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.35
|
| Rate for Payer: Vantage Medical Group Senior |
$366.35
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104139
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.01 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.10
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.79
|
| Rate for Payer: Heritage Provider Network Senior |
$291.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.75
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
IP
|
$211.00
|
|
| Hospital Charge Code |
901300603
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.96
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.85
|
| Rate for Payer: Heritage Provider Network Senior |
$142.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
OP
|
$211.00
|
|
| Hospital Charge Code |
901300603
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$179.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$158.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.35
|
| Rate for Payer: Dignity Health Senior |
$179.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.61
|
| Rate for Payer: Heritage Provider Network Senior |
$130.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.35
|
| Rate for Payer: Vantage Medical Group Senior |
$179.35
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
IP
|
$203.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$152.25 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.46
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.43
|
| Rate for Payer: Heritage Provider Network Senior |
$137.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.75
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
OP
|
$203.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$108.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.55
|
| Rate for Payer: Dignity Health Senior |
$172.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.66
|
| Rate for Payer: Heritage Provider Network Senior |
$125.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.75
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.55
|
| Rate for Payer: Vantage Medical Group Senior |
$172.55
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
IP
|
$299.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.41
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.42
|
| Rate for Payer: Heritage Provider Network Senior |
$202.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
OP
|
$299.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$164.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$224.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$194.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$254.15
|
| Rate for Payer: Dignity Health Senior |
$254.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.08
|
| Rate for Payer: Heritage Provider Network Senior |
$185.08
|
| Rate for Payer: IEHP Medi-Cal |
$17.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$254.15
|
| Rate for Payer: Vantage Medical Group Senior |
$254.15
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$438.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$380.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$497.25
|
| Rate for Payer: Dignity Health Senior |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.12
|
| Rate for Payer: Heritage Provider Network Senior |
$362.12
|
| Rate for Payer: IEHP Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$281.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.90
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.04
|
| Rate for Payer: Heritage Provider Network Senior |
$396.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
|
