|
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 |
$503.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| 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
|
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: 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: Adventist Health Commercial |
$534.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.36
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$912.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$827.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$768.77
|
| 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 |
$586.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$912.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$827.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$768.77
|
| 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 |
$406.36
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$912.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$827.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$768.77
|
| 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 |
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 |
$586.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$912.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$827.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$768.77
|
| 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 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 |
$406.36
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| 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 |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| 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 |
$390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| 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
|
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 |
$406.36
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| 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 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 |
$406.36
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| 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 |
$488.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| 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
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
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 |
$406.36
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| 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: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$760.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.74
|
| 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
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$324.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$554.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| 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 |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$224.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$274.82
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$383.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$347.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.32
|
| 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
|
|
|
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 |
$246.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$383.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$347.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.32
|
| 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 SUBSTITUTION
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.65
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$123.37
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$113.28
|
| Rate for Payer: Cigna of CA PPO |
$130.98
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$4.33
|
| Rate for Payer: EPIC Health Plan Senior |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
|
HC PT SUBSTITUTION
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
|
|
HC PTT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.98
|
| Rate for Payer: Blue Shield of California Commercial |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$128.25
|
| Rate for Payer: Blue Shield of California Commercial |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$84.82
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$26.74
|
| Rate for Payer: Blue Shield of California Commercial |
$128.25
|
| Rate for Payer: Blue Shield of California Commercial |
$40.43
|
| Rate for Payer: Blue Shield of California Commercial |
$84.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.58 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$477.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,030.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,313.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,791.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cigna of CA HMO |
$1,552.85
|
| Rate for Payer: Cigna of CA PPO |
$1,767.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,030.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,030.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,030.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,672.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$955.60
|
| Rate for Payer: Galaxy Health WC |
$2,030.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,433.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,517.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,409.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,672.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,672.30
|
| Rate for Payer: Multiplan Commercial |
$1,911.20
|
| Rate for Payer: Networks By Design Commercial |
$1,552.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,030.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,433.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,433.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,194.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,030.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,030.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,030.65
|
|
