|
HC OSMOLALITY STOOL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.22
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California EPN |
$13.31
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.82
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.22
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California EPN |
$13.31
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.82
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$60.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.99
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.88
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.20
|
| Rate for Payer: Dignity Health Media |
$7.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.47
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.25
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.01
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.05
|
| Rate for Payer: United Healthcare HMO Rider |
$6.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$121.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.87
|
| Rate for Payer: Blue Distinction Transplant |
$31.20
|
| Rate for Payer: Blue Shield of California Commercial |
$33.59
|
| Rate for Payer: Blue Shield of California EPN |
$26.62
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.04
|
| Rate for Payer: Dignity Health Media |
$13.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.36
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Vantage Medical Group Senior |
$13.36
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.40
|
| Rate for Payer: Dignity Health Media |
$54.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54.40
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$660.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$704.00
|
| Rate for Payer: Cigna of CA PPO |
$814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.00
|
| Rate for Payer: Dignity Health Media |
$935.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.00
|
| Rate for Payer: Vantage Medical Group Senior |
$935.00
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$660.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$704.00
|
| Rate for Payer: Cigna of CA PPO |
$814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.00
|
| Rate for Payer: Dignity Health Media |
$935.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.00
|
| Rate for Payer: Vantage Medical Group Senior |
$935.00
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$440.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.90
|
| Rate for Payer: Dignity Health Media |
$623.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.90
|
| Rate for Payer: Vantage Medical Group Senior |
$623.90
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$440.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.90
|
| Rate for Payer: Dignity Health Media |
$623.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.90
|
| Rate for Payer: Vantage Medical Group Senior |
$623.90
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$779.45 |
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$779.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$504.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$550.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO |
$586.88
|
| Rate for Payer: Cigna of CA PPO |
$678.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Media |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$687.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$779.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$504.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$550.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO |
$586.88
|
| Rate for Payer: Cigna of CA PPO |
$678.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Media |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$687.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$779.45 |
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
OP
|
$717.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.34 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$430.20
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: Cigna of CA PPO |
$530.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$537.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$573.60
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.50
|
| Rate for Payer: United Healthcare All Other HMO |
$358.50
|
| Rate for Payer: United Healthcare HMO Rider |
$358.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$717.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.08 |
| Max. Negotiated Rate |
$609.45 |
| Rate for Payer: Cash Price |
$322.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.80
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.08
|
| Rate for Payer: Multiplan Commercial |
$573.60
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
912197004
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$539.75 |
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
912197004
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$539.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$349.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$349.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO |
$406.40
|
| Rate for Payer: Cigna of CA PPO |
$469.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.75
|
| Rate for Payer: Dignity Health Media |
$539.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$539.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$539.75
|
| Rate for Payer: Vantage Medical Group Senior |
$539.75
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
908603273
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$539.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$349.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$349.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO |
$406.40
|
| Rate for Payer: Cigna of CA PPO |
$469.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.75
|
| Rate for Payer: Dignity Health Media |
$539.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$539.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$539.75
|
| Rate for Payer: Vantage Medical Group Senior |
$539.75
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
908603273
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$539.75 |
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.00
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$80.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.77
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.88
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Media |
$8.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
