|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Central Health Plan Commercial |
$760.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$665.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.40
|
| Rate for Payer: EPIC Health Plan Senior |
$380.40
|
| Rate for Payer: Galaxy Health WC |
$808.35
|
| Rate for Payer: Global Benefits Group Commercial |
$570.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$855.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$603.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.20
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: Networks By Design Commercial |
$618.15
|
| Rate for Payer: Prime Health Services Commercial |
$808.35
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.50
|
| 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 |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Riverside University Health System MISP |
$253.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| 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 |
$538.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.90
|
| Rate for Payer: Vantage Medical Group Senior |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.50
|
| 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 |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Riverside University Health System MISP |
$253.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| 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 |
$538.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.90
|
| Rate for Payer: Vantage Medical Group Senior |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.50
|
| 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 |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Riverside University Health System MISP |
$253.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| 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 |
$538.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.90
|
| Rate for Payer: Vantage Medical Group Senior |
$538.90
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$570.60 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.50
|
| 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 |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Central Health Plan Commercial |
$507.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$443.80
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Riverside University Health System MISP |
$253.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| 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 |
$538.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.90
|
| Rate for Payer: Vantage Medical Group Senior |
$538.90
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$324.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$324.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$324.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$324.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
IP
|
$569.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
OP
|
$569.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| 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 |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$364.16
|
| Rate for Payer: Cigna of CA PPO |
$421.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$335.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| 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 |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
|
IP
|
$618.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| 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 PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
|
OP
|
$618.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| 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 PT PRELIMINARY EVALUATION
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
903200136
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
|
|
HC PT PRELIMINARY EVALUATION
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
903200136
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$193.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.25
|
| 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 |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Cigna of CA HMO |
$301.44
|
| Rate for Payer: Cigna of CA PPO |
$348.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$400.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$400.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$329.70
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: Riverside University Health System MISP |
$188.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.35
|
| Rate for Payer: Vantage Medical Group Senior |
$400.35
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| 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 |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
