|
HC OSTOMY BELT ELASTIC 43 1/3IN
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901608098
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.96
|
| Rate for Payer: Blue Distinction Transplant |
$12.15
|
| Rate for Payer: Blue Shield of California Commercial |
$15.19
|
| Rate for Payer: Blue Shield of California EPN |
$11.02
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$14.18
|
| Rate for Payer: Cigna of CA PPO |
$14.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.21
|
| Rate for Payer: Dignity Health Media |
$17.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Riverside University Health System MISP |
$8.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.21
|
| Rate for Payer: Vantage Medical Group Senior |
$17.21
|
|
|
HC OSTOMY STOMAHESIVE PWDR 1 OZ
|
Facility
|
OP
|
$7.54
|
|
| Hospital Charge Code |
901698253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.45
|
| Rate for Payer: Blue Distinction Transplant |
$4.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Central Health Plan Commercial |
$6.03
|
| Rate for Payer: Cigna of CA HMO |
$4.83
|
| Rate for Payer: Cigna of CA PPO |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Media |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.02
|
| Rate for Payer: Galaxy Health WC |
$6.41
|
| Rate for Payer: Global Benefits Group Commercial |
$4.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.41
|
| Rate for Payer: Riverside University Health System MISP |
$3.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.77
|
| Rate for Payer: United Healthcare All Other HMO |
$3.77
|
| Rate for Payer: United Healthcare HMO Rider |
$3.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.41
|
| Rate for Payer: Vantage Medical Group Senior |
$6.41
|
|
|
HC OSTOMY STOMAHESIVE PWDR 1 OZ
|
Facility
|
IP
|
$7.54
|
|
| Hospital Charge Code |
901698253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Central Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.02
|
| Rate for Payer: Galaxy Health WC |
$6.41
|
| Rate for Payer: Global Benefits Group Commercial |
$4.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.41
|
|
|
HC OS WOUND DRAIN MED W/BARRIER
|
Facility
|
IP
|
$42.56
|
|
| Hospital Charge Code |
901601580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$34.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: Galaxy Health WC |
$36.18
|
| Rate for Payer: Global Benefits Group Commercial |
$25.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$31.92
|
| Rate for Payer: Networks By Design Commercial |
$27.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.18
|
|
|
HC OS WOUND DRAIN MED W/BARRIER
|
Facility
|
OP
|
$42.56
|
|
| Hospital Charge Code |
901601580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.14
|
| Rate for Payer: Blue Distinction Transplant |
$25.54
|
| Rate for Payer: Blue Shield of California Commercial |
$26.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.81
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$34.05
|
| Rate for Payer: Cigna of CA HMO |
$27.24
|
| Rate for Payer: Cigna of CA PPO |
$31.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.18
|
| Rate for Payer: Dignity Health Media |
$36.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.02
|
| Rate for Payer: Galaxy Health WC |
$36.18
|
| Rate for Payer: Global Benefits Group Commercial |
$25.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$31.92
|
| Rate for Payer: Networks By Design Commercial |
$27.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.18
|
| Rate for Payer: Riverside University Health System MISP |
$17.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.28
|
| Rate for Payer: United Healthcare All Other HMO |
$21.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.18
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$39.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
| Rate for Payer: Dignity Health Media |
$56.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$49.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Riverside University Health System MISP |
$26.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Vantage Medical Group Senior |
$56.10
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$888.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$574.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: Cigna of CA HMO |
$668.80
|
| Rate for Payer: Cigna of CA PPO |
$773.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$888.25
|
| Rate for Payer: Dignity Health Media |
$888.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$888.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$418.00
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$365.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.45
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
| Rate for Payer: Riverside University Health System MISP |
$418.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$888.25
|
| Rate for Payer: Vantage Medical Group Senior |
$888.25
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$888.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$574.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: Cigna of CA HMO |
$668.80
|
| Rate for Payer: Cigna of CA PPO |
$773.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$888.25
|
| Rate for Payer: Dignity Health Media |
$888.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$888.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$418.00
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$365.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.45
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
| Rate for Payer: Riverside University Health System MISP |
$418.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$888.25
|
| Rate for Payer: Vantage Medical Group Senior |
$888.25
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.00
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.00
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$888.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$574.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: Cigna of CA HMO |
$668.80
|
| Rate for Payer: Cigna of CA PPO |
$773.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$888.25
|
| Rate for Payer: Dignity Health Media |
$888.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$888.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$418.00
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$365.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.45
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
| Rate for Payer: Riverside University Health System MISP |
$418.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$888.25
|
| Rate for Payer: Vantage Medical Group Senior |
$888.25
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Central Health Plan Commercial |
$836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.00
|
| Rate for Payer: Galaxy Health WC |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$940.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
901397165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$446.08
|
| Rate for Payer: Cigna of CA PPO |
$515.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Media |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$522.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$446.08
|
| Rate for Payer: Cigna of CA PPO |
$515.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Media |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$522.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$446.08
|
| Rate for Payer: Cigna of CA PPO |
$515.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Media |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$522.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
901397165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
905197165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: Cigna of CA HMO |
$557.44
|
| Rate for Payer: Cigna of CA PPO |
$644.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.35
|
| Rate for Payer: Dignity Health Media |
$740.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$740.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$653.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.11
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
| Rate for Payer: Riverside University Health System MISP |
$348.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$740.35
|
| Rate for Payer: Vantage Medical Group Senior |
$740.35
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
905197166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.20
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: Cigna of CA HMO |
$557.44
|
| Rate for Payer: Cigna of CA PPO |
$644.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.35
|
| Rate for Payer: Dignity Health Media |
$740.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$740.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$653.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.11
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
| Rate for Payer: Riverside University Health System MISP |
$348.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$740.35
|
| Rate for Payer: Vantage Medical Group Senior |
$740.35
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.20
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: Cigna of CA HMO |
$557.44
|
| Rate for Payer: Cigna of CA PPO |
$644.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.35
|
| Rate for Payer: Dignity Health Media |
$740.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$740.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$653.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.11
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
| Rate for Payer: Riverside University Health System MISP |
$348.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$740.35
|
| Rate for Payer: Vantage Medical Group Senior |
$740.35
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$783.90 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Central Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: Galaxy Health WC |
$740.35
|
| Rate for Payer: Global Benefits Group Commercial |
$522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$783.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.20
|
| Rate for Payer: Multiplan Commercial |
$653.25
|
| Rate for Payer: Networks By Design Commercial |
$566.15
|
| Rate for Payer: Prime Health Services Commercial |
$740.35
|
|
