|
HC OTHER ALLIED CONF PARTCP 15MIN
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
908600159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.32
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC OTHER ALLIED HLTH CONF COORD
|
Facility
|
OP
|
$278.00
|
|
| Hospital Charge Code |
908600155
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.72
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.00
|
| Rate for Payer: United Healthcare All Other HMO |
$139.00
|
| Rate for Payer: United Healthcare HMO Rider |
$139.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC OTHER ALLIED HLTH CONF COORD
|
Facility
|
IP
|
$278.00
|
|
| Hospital Charge Code |
908600155
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC OTHER ALLIED HLTH GRP TEACH
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
908600137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.48
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC OTHER ALLIED HLTH GRP TEACH
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
908600137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC OTHER ALLIEDHLTH GRP TEACH
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
912164316
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.48
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC OTHER ALLIEDHLTH GRP TEACH
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
912164316
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC OTHER ALLIED HLTH PHONE 15 MIN
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
908603060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.12
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC OTHER ALLIED HLTH PHONE 15 MIN
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
908603060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC OTHER PT/OT CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8990
|
| Hospital Charge Code |
900018312
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8990
|
| Hospital Charge Code |
900018312
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC OTHER PT/OT D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8992
|
| Hospital Charge Code |
900018314
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8992
|
| Hospital Charge Code |
900018314
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC OTHER PT/OT GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8991
|
| Hospital Charge Code |
900018313
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC OTHER PT/OT GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8991
|
| Hospital Charge Code |
900018313
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER ULTRASOUND PROCEDURE
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
906811769
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,279.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,197.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.40
|
| Rate for Payer: Blue Shield of California EPN |
$787.80
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cigna of CA HMO |
$1,248.00
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OTHER ULTRASOUND PROCEDURE
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
906811769
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Senior |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: Adventist Health Commercial |
$473.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$758.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$982.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$635.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$867.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna of CA HMO |
$739.84
|
| Rate for Payer: Cigna of CA PPO |
$855.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$982.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$982.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$982.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$462.40
|
| Rate for Payer: Galaxy Health WC |
$982.60
|
| Rate for Payer: Global Benefits Group Commercial |
$693.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$771.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$715.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$809.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$809.20
|
| Rate for Payer: Multiplan Commercial |
$924.80
|
| Rate for Payer: Networks By Design Commercial |
$751.40
|
| Rate for Payer: Prime Health Services Commercial |
$982.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$693.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$693.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$982.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$982.60
|
| Rate for Payer: Vantage Medical Group Senior |
$982.60
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: Adventist Health Commercial |
$231.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$462.40
|
| Rate for Payer: Galaxy Health WC |
$982.60
|
| Rate for Payer: Global Benefits Group Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$771.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$715.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.44
|
| Rate for Payer: Multiplan Commercial |
$924.80
|
| Rate for Payer: Networks By Design Commercial |
$751.40
|
| Rate for Payer: Prime Health Services Commercial |
$982.60
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: Adventist Health Commercial |
$473.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$758.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$982.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$635.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$867.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna of CA HMO |
$739.84
|
| Rate for Payer: Cigna of CA PPO |
$855.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$982.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$982.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$982.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$462.40
|
| Rate for Payer: Galaxy Health WC |
$982.60
|
| Rate for Payer: Global Benefits Group Commercial |
$693.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$771.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$715.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$809.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$809.20
|
| Rate for Payer: Multiplan Commercial |
$924.80
|
| Rate for Payer: Networks By Design Commercial |
$751.40
|
| Rate for Payer: Prime Health Services Commercial |
$982.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$693.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$693.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$982.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$982.60
|
| Rate for Payer: Vantage Medical Group Senior |
$982.60
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$982.60 |
| Rate for Payer: Adventist Health Commercial |
$231.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$462.40
|
| Rate for Payer: Galaxy Health WC |
$982.60
|
| Rate for Payer: Global Benefits Group Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$771.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$715.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.44
|
| Rate for Payer: Multiplan Commercial |
$924.80
|
| Rate for Payer: Networks By Design Commercial |
$751.40
|
| Rate for Payer: Prime Health Services Commercial |
$982.60
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$185.04 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$316.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$655.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$424.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$578.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$655.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$655.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$655.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$477.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$539.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$539.70
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$462.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$655.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$655.35
|
| Rate for Payer: Vantage Medical Group Senior |
$655.35
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$154.40 |
| Max. Negotiated Rate |
$656.20 |
| Rate for Payer: Adventist Health Commercial |
$154.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.80
|
| Rate for Payer: EPIC Health Plan Senior |
$308.80
|
| Rate for Payer: Galaxy Health WC |
$656.20
|
| Rate for Payer: Global Benefits Group Commercial |
$463.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$477.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.28
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: Networks By Design Commercial |
$501.80
|
| Rate for Payer: Prime Health Services Commercial |
$656.20
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$185.28 |
| Max. Negotiated Rate |
$656.20 |
| Rate for Payer: Adventist Health Commercial |
$316.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$506.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$656.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$424.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$579.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna of CA HMO |
$494.08
|
| Rate for Payer: Cigna of CA PPO |
$571.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$656.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$656.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.80
|
| Rate for Payer: EPIC Health Plan Senior |
$308.80
|
| Rate for Payer: Galaxy Health WC |
$656.20
|
| Rate for Payer: Global Benefits Group Commercial |
$463.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$477.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$540.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$540.40
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: Networks By Design Commercial |
$501.80
|
| Rate for Payer: Prime Health Services Commercial |
$656.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$656.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$656.20
|
| Rate for Payer: Vantage Medical Group Senior |
$656.20
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$477.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
|
