|
HC OTHER ULTRASOUND PROCEDURE
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
906811769
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$1,796.40 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.40
|
| Rate for Payer: EPIC Health Plan Senior |
$798.40
|
| Rate for Payer: Galaxy Health WC |
$1,696.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,796.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,331.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,235.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.20
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Networks By Design Commercial |
$1,297.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,696.60
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$540.16
|
| Rate for Payer: Cigna of CA PPO |
$624.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.27
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$540.16
|
| Rate for Payer: Cigna of CA PPO |
$624.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.27
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$540.16
|
| Rate for Payer: Cigna of CA PPO |
$624.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.27
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
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 |
$309.65
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| 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 Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| 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
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
901397165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Adventist Health Commercial |
$230.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$341.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.55
|
| 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: InnovAge PACE Commercial |
$281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.10
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$225.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| 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 |
$478.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
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 |
$309.65
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| 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 Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| 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 |
$309.65
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| 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 Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| 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
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Adventist Health Commercial |
$230.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$341.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.55
|
| 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: InnovAge PACE Commercial |
$281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.10
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$225.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| 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 |
$478.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$506.70 |
| Rate for Payer: Adventist Health Commercial |
$230.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$341.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Central Health Plan Commercial |
$450.40
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.55
|
| 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: InnovAge PACE Commercial |
$281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.10
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$225.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| 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 |
$478.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
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 |
$426.93
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| 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: 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: InnovAge PACE Commercial |
$351.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$426.93
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| 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: 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: InnovAge PACE Commercial |
$351.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| 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 Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| 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 |
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 |
$426.93
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| 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: 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: InnovAge PACE Commercial |
$351.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| 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 Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| 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 |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| 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 Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| 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 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 |
$2,696.00 |
| 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 |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cash Price |
$518.10
|
| 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 |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| 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 |
$647.05
|
| 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 |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| 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 |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC 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 |
$518.10
|
| Rate for Payer: Central Health Plan Commercial |
$753.60
|
| 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 Permanente of CA Commercial/Self Funded |
$628.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.10
|
| 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 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 |
$339.90
|
| Rate for Payer: Central Health Plan Commercial |
$494.40
|
| 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 Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| 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 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| 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: 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: InnovAge PACE Commercial |
$309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$432.60
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$199.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.76
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| 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: 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: InnovAge PACE Commercial |
$243.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$267.85
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| 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 Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| 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
|
|
