|
HC THERAPEUTIC INJECTION IA
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
909020041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.83
|
| Rate for Payer: Heritage Provider Network Senior |
$365.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$281.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$300.93
|
| Rate for Payer: TriValley Medical Group Senior |
$273.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC THERAPEUTIC INJECTION IA
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
909020041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$443.25 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.11
|
| Rate for Payer: Heritage Provider Network Senior |
$400.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCAL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
907000036
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCAL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
907000036
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN MCARE COMM
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900407110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN OT
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
901309044
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$85.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$177.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.75
|
| 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 |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
| 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 |
$177.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.65
|
| Rate for Payer: Vantage Medical Group Senior |
$177.65
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN OT
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
901309044
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.60
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.49
|
| Rate for Payer: Heritage Provider Network Senior |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 15MIN OT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905103225
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905103225
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410478
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN PT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410478
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN ST
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905601304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 15 MIN ST
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905601304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$85.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$177.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.75
|
| 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 |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
| 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 |
$177.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.65
|
| Rate for Payer: Vantage Medical Group Senior |
$177.65
|
|
|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.60
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.49
|
| Rate for Payer: Heritage Provider Network Senior |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104139
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
905104139
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
901300603
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| 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 |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.32
|
| Rate for Payer: Heritage Provider Network Senior |
$134.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| 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 |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC THERAPEUTIC PROCEDURE 30 MIN OT
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
901300603
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.75
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.91
|
| Rate for Payer: Heritage Provider Network Senior |
$146.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
900410402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$85.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$177.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.75
|
| 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 |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$177.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$177.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
| 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 |
$177.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$177.65
|
| Rate for Payer: Vantage Medical Group Senior |
$177.65
|
|
