|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,703.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.81
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
OP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.60 |
| Max. Negotiated Rate |
$1,651.55 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,274.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,068.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,457.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,193.20
|
| Rate for Payer: Cash Price |
$1,068.65
|
| Rate for Payer: Cigna of CA HMO |
$1,243.52
|
| Rate for Payer: Cigna of CA PPO |
$1,437.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$777.20
|
| Rate for Payer: Galaxy Health WC |
$1,651.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,165.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,360.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,360.10
|
| Rate for Payer: Multiplan Commercial |
$1,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,262.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,651.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,165.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,165.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$971.50
|
| Rate for Payer: United Healthcare All Other HMO |
$971.50
|
| Rate for Payer: United Healthcare HMO Rider |
$971.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
IP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.60 |
| Max. Negotiated Rate |
$1,651.55 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$1,068.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$777.20
|
| Rate for Payer: Galaxy Health WC |
$1,651.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,165.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.32
|
| Rate for Payer: Multiplan Commercial |
$1,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,262.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,651.55
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$23,930.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,786.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: Cigna of CA HMO |
$15,554.50
|
| Rate for Payer: Cigna of CA PPO |
$17,708.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$20,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,358.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$731.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,961.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,743.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$19,144.00
|
| Rate for Payer: Networks By Design Commercial |
$15,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$20,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,358.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$24,622.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,924.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$13,542.10
|
| Rate for Payer: Cash Price |
$13,542.10
|
| Rate for Payer: Cash Price |
$13,542.10
|
| Rate for Payer: Cigna of CA HMO |
$16,004.30
|
| Rate for Payer: Cigna of CA PPO |
$18,220.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$20,928.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14,773.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$731.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,422.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$19,697.60
|
| Rate for Payer: Networks By Design Commercial |
$16,004.30
|
| Rate for Payer: Prime Health Services Commercial |
$20,928.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,773.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,773.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$23,930.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,786.00 |
| Max. Negotiated Rate |
$20,340.50 |
| Rate for Payer: Adventist Health Commercial |
$4,786.00
|
| Rate for Payer: Cash Price |
$13,161.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,572.00
|
| Rate for Payer: Galaxy Health WC |
$20,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,961.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,117.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,812.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,743.20
|
| Rate for Payer: Multiplan Commercial |
$19,144.00
|
| Rate for Payer: Networks By Design Commercial |
$15,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$20,340.50
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$24,622.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,924.40 |
| Max. Negotiated Rate |
$20,928.70 |
| Rate for Payer: Adventist Health Commercial |
$4,924.40
|
| Rate for Payer: Cash Price |
$13,542.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,848.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,848.80
|
| Rate for Payer: Galaxy Health WC |
$20,928.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14,773.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,422.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,380.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,241.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.28
|
| Rate for Payer: Multiplan Commercial |
$19,697.60
|
| Rate for Payer: Networks By Design Commercial |
$16,004.30
|
| Rate for Payer: Prime Health Services Commercial |
$20,928.70
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
IP
|
$1,118.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
OP
|
$1,118.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$733.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| 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 |
$614.90
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| 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 |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
908697163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
908697163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$534.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$854.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$716.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$977.25
|
| 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 |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cigna of CA HMO |
$833.92
|
| Rate for Payer: Cigna of CA PPO |
$964.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,107.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,107.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$912.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$912.10
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$781.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$781.80
|
| 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 |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,107.55
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$534.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$854.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$716.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$977.25
|
| 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 |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cigna of CA HMO |
$833.92
|
| Rate for Payer: Cigna of CA PPO |
$964.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,107.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,107.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$912.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$912.10
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$781.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$781.80
|
| 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 |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,107.55
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$737.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.00
|
| 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 |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$737.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$737.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$737.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$607.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$607.60
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.80
|
| 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 |
$737.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$737.80
|
| Rate for Payer: Vantage Medical Group Senior |
$737.80
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
908697161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$737.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.00
|
| 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 |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$737.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$737.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$737.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$607.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$607.60
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.80
|
| 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 |
$737.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$737.80
|
| Rate for Payer: Vantage Medical Group Senior |
$737.80
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
908697161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
908697162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$445.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| 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 |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| 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 |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
908697162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$445.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| 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 |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| 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 |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$465.80 |
| Rate for Payer: Adventist Health Commercial |
$109.60
|
| Rate for Payer: Cash Price |
$301.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Senior |
$219.20
|
| Rate for Payer: Galaxy Health WC |
$465.80
|
| Rate for Payer: Global Benefits Group Commercial |
$328.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.52
|
| Rate for Payer: Multiplan Commercial |
$438.40
|
| Rate for Payer: Networks By Design Commercial |
$356.20
|
| Rate for Payer: Prime Health Services Commercial |
$465.80
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$465.80 |
| Rate for Payer: Adventist Health Commercial |
$224.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$465.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$411.00
|
| 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 |
$301.40
|
| Rate for Payer: Cash Price |
$301.40
|
| Rate for Payer: Cash Price |
$301.40
|
| Rate for Payer: Cash Price |
$301.40
|
| Rate for Payer: Cigna of CA HMO |
$350.72
|
| Rate for Payer: Cigna of CA PPO |
$405.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$465.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Senior |
$219.20
|
| Rate for Payer: Galaxy Health WC |
$465.80
|
| Rate for Payer: Global Benefits Group Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$383.60
|
| Rate for Payer: Multiplan Commercial |
$438.40
|
| Rate for Payer: Networks By Design Commercial |
$356.20
|
| Rate for Payer: Prime Health Services Commercial |
$465.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$328.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.80
|
| 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 |
$465.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.80
|
| Rate for Payer: Vantage Medical Group Senior |
$465.80
|
|
