|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$506.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$357.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.60
|
| Rate for Payer: Multiplan Commercial |
$422.25
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
901397165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$506.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$357.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.60
|
| Rate for Payer: Multiplan Commercial |
$422.25
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$449.92
|
| Rate for Payer: Cigna of CA PPO |
$520.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| 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 |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$449.92
|
| Rate for Payer: Cigna of CA PPO |
$520.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| 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 |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$449.92
|
| Rate for Payer: Cigna of CA PPO |
$520.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| 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 |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$847.80 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$659.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.80
|
| Rate for Payer: EPIC Health Plan Senior |
$376.80
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$847.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$555.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.34 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$188.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| Rate for Payer: Cigna of CA HMO |
$602.88
|
| Rate for Payer: Cigna of CA PPO |
$697.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$659.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$800.70
|
| Rate for Payer: Global Benefits Group Commercial |
$565.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$847.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$706.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$612.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$800.70
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.00
|
| Rate for Payer: United Healthcare All Other HMO |
$471.00
|
| Rate for Payer: United Healthcare HMO Rider |
$471.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
|
OP
|
$618.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$253.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$525.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$463.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: Cigna of CA HMO |
$395.52
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$525.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$525.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$525.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$432.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$392.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$432.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Riverside University Health System MISP |
$247.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| 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 |
$525.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$525.30
|
| Rate for Payer: Vantage Medical Group Senior |
$525.30
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
|
IP
|
$618.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$432.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$556.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$392.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$199.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$274.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Cigna of CA HMO |
$311.68
|
| Rate for Payer: Cigna of CA PPO |
$360.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$340.90
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: Riverside University Health System MISP |
$194.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.20
|
| 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 |
$413.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.95
|
| Rate for Payer: Vantage Medical Group Senior |
$413.95
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$438.30 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.40
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.55
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.55
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$7.30
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$9.69
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Central Health Plan Commercial |
$9.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.56
|
| Rate for Payer: Galaxy Health WC |
$9.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Networks By Design Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$9.69
|
|
|
HC OT TASK GROUP
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804025
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC OT TASK GROUP
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804025
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC OUTBACK CATHETER
|
Facility
|
OP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,791.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,806.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,317.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,783.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,070.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,060.00
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,313.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,313.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,567.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,222.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,842.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,994.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,552.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,030.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,045.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,045.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,313.75
|
|
|
HC OUTBACK CATHETER
|
Facility
|
IP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,070.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,557.80
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,060.00
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,567.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,222.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,994.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,904.65
|
| Rate for Payer: United Healthcare All Other HMO |
$1,853.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,813.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.06
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
915353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
