|
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: Cash Price |
$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: 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 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: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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
|
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: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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: Cash Price |
$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: 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: Cash Price |
$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: 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: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| 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
|
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 |
$1,072.50
|
| 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 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 |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| 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 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 |
$635.80
|
| 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 |
$635.80
|
| Rate for Payer: Cash Price |
$635.80
|
| Rate for Payer: Cash Price |
$635.80
|
| Rate for Payer: Cash Price |
$635.80
|
| 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
|
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 |
$635.80
|
| Rate for Payer: Cash Price |
$635.80
|
| Rate for Payer: Cash Price |
$635.80
|
| Rate for Payer: Cash Price |
$635.80
|
| 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 |
$635.80
|
| 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
|
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 |
$424.05
|
| 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
|
|
|
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 |
$424.05
|
| Rate for Payer: Cash Price |
$424.05
|
| Rate for Payer: Cash Price |
$424.05
|
| 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 |
$424.60
|
| 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 |
$424.60
|
| Rate for Payer: Cash Price |
$424.60
|
| Rate for Payer: Cash Price |
$424.60
|
| 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 MODERATE
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$395.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$632.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$530.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$723.00
|
| 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 |
$530.20
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$819.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$819.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$819.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.80
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.40
|
| 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 |
$819.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$819.40
|
| Rate for Payer: Vantage Medical Group Senior |
$819.40
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: Adventist Health Commercial |
$394.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$631.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.25
|
| 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 |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.10
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.80
|
| 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 |
$818.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.55
|
| Rate for Payer: Vantage Medical Group Senior |
$818.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$717.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$609.45 |
| Rate for Payer: Adventist Health Commercial |
$143.40
|
| Rate for Payer: Cash Price |
$394.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$443.82
|
| 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 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 |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$143.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$394.35
|
| Rate for Payer: Cash Price |
$394.35
|
| Rate for Payer: Cash Price |
$394.35
|
| Rate for Payer: Cigna of CA HMO |
$458.88
|
| Rate for Payer: Cigna of CA PPO |
$530.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$609.45
|
| Rate for Payer: Global Benefits Group Commercial |
$430.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| 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 |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$573.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$466.05
|
| Rate for Payer: Prime Health Services Commercial |
$609.45
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| 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: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
912197004
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
908603273
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$272.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.75
|
| 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 |
$365.75
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: Cigna of CA HMO |
$425.60
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$465.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$465.50
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.00
|
| 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 |
$565.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
912197004
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Adventist Health Commercial |
$272.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.75
|
| 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 |
$365.75
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: Cash Price |
$365.75
|
| Rate for Payer: Cigna of CA HMO |
$425.60
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$465.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$465.50
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.00
|
| 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 |
$565.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
