|
HC PT ED GRP 2-5 PTS 60 MIN PT
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905103212
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$173.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.30
|
| 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 |
$171.60
|
| 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 |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Central Health Plan Commercial |
$228.80
|
| Rate for Payer: Cigna of CA HMO |
$183.04
|
| Rate for Payer: Cigna of CA PPO |
$211.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Media |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$214.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.26
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Networks By Design Commercial |
$185.90
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
| Rate for Payer: Riverside University Health System MISP |
$114.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.60
|
| 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 |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN PT
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905103212
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Central Health Plan Commercial |
$228.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.40
|
| Rate for Payer: Galaxy Health WC |
$243.10
|
| Rate for Payer: Global Benefits Group Commercial |
$171.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.20
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Networks By Design Commercial |
$185.90
|
| Rate for Payer: Prime Health Services Commercial |
$243.10
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
IP
|
$973.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$875.70 |
| Rate for Payer: Cash Price |
$437.85
|
| Rate for Payer: Central Health Plan Commercial |
$778.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.20
|
| Rate for Payer: Galaxy Health WC |
$827.05
|
| Rate for Payer: Global Benefits Group Commercial |
$583.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$875.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.60
|
| Rate for Payer: Multiplan Commercial |
$729.75
|
| Rate for Payer: Networks By Design Commercial |
$632.45
|
| Rate for Payer: Prime Health Services Commercial |
$827.05
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
OP
|
$973.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$875.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$590.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.15
|
| 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 |
$583.80
|
| 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 |
$437.85
|
| Rate for Payer: Cash Price |
$437.85
|
| Rate for Payer: Cash Price |
$437.85
|
| Rate for Payer: Central Health Plan Commercial |
$778.40
|
| Rate for Payer: Cigna of CA HMO |
$622.72
|
| Rate for Payer: Cigna of CA PPO |
$720.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.05
|
| Rate for Payer: Dignity Health Media |
$827.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$389.20
|
| Rate for Payer: Galaxy Health WC |
$827.05
|
| Rate for Payer: Global Benefits Group Commercial |
$583.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$875.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$729.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$340.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.93
|
| Rate for Payer: Multiplan Commercial |
$729.75
|
| Rate for Payer: Networks By Design Commercial |
$632.45
|
| Rate for Payer: Prime Health Services Commercial |
$827.05
|
| Rate for Payer: Riverside University Health System MISP |
$389.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$583.80
|
| 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 |
$827.05
|
| Rate for Payer: Vantage Medical Group Senior |
$827.05
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
905197163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$647.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.90
|
| 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 |
$706.80
|
| 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 |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Cigna of CA HMO |
$753.92
|
| Rate for Payer: Cigna of CA PPO |
$871.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Dignity Health Media |
$1,001.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$883.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.98
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Riverside University Health System MISP |
$471.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.80
|
| 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 |
$1,001.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900407163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.60
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
905197163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.60
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900417163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.60
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900417163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$647.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.90
|
| 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 |
$706.80
|
| 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 |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Cigna of CA HMO |
$753.92
|
| Rate for Payer: Cigna of CA PPO |
$871.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Dignity Health Media |
$1,001.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$883.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.98
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Riverside University Health System MISP |
$471.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.80
|
| 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 |
$1,001.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900407163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$647.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.90
|
| 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 |
$706.80
|
| 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 |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Cigna of CA HMO |
$753.92
|
| Rate for Payer: Cigna of CA PPO |
$871.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Dignity Health Media |
$1,001.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$883.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.98
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Riverside University Health System MISP |
$471.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.80
|
| 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 |
$1,001.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$647.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.90
|
| 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 |
$706.80
|
| 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 |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: Cigna of CA HMO |
$753.92
|
| Rate for Payer: Cigna of CA PPO |
$871.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Dignity Health Media |
$1,001.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$883.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.98
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
| Rate for Payer: Riverside University Health System MISP |
$471.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.80
|
| 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 |
$1,001.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,001.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Central Health Plan Commercial |
$942.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.20
|
| Rate for Payer: Galaxy Health WC |
$1,001.30
|
| Rate for Payer: Global Benefits Group Commercial |
$706.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,060.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.60
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: Networks By Design Commercial |
$765.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.30
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$667.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$431.75
|
| 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 |
$471.00
|
| 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 |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$667.25
|
| Rate for Payer: Dignity Health Media |
$667.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$588.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.85
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Riverside University Health System MISP |
$314.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.00
|
| 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 |
$667.25
|
| Rate for Payer: Vantage Medical Group Senior |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$667.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$431.75
|
| 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 |
$471.00
|
| 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 |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$667.25
|
| Rate for Payer: Dignity Health Media |
$667.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$588.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.85
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Riverside University Health System MISP |
$314.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.00
|
| 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 |
$667.25
|
| Rate for Payer: Vantage Medical Group Senior |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$667.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$431.75
|
| 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 |
$471.00
|
| 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 |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$667.25
|
| Rate for Payer: Dignity Health Media |
$667.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$588.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.85
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Riverside University Health System MISP |
$314.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.00
|
| 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 |
$667.25
|
| Rate for Payer: Vantage Medical Group Senior |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$667.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$431.75
|
| 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 |
$471.00
|
| 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 |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$667.25
|
| Rate for Payer: Dignity Health Media |
$667.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$588.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.85
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Riverside University Health System MISP |
$314.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.00
|
| 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 |
$667.25
|
| Rate for Payer: Vantage Medical Group Senior |
$667.25
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$706.50 |
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Central Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$539.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$539.55
|
| 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 |
$588.60
|
| 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 |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Central Health Plan Commercial |
$784.80
|
| Rate for Payer: Cigna of CA HMO |
$627.84
|
| Rate for Payer: Cigna of CA PPO |
$725.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.85
|
| Rate for Payer: Dignity Health Media |
$833.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.40
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$735.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$343.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.21
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
| Rate for Payer: Riverside University Health System MISP |
$392.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$588.60
|
| 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 |
$833.85
|
| Rate for Payer: Vantage Medical Group Senior |
$833.85
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Central Health Plan Commercial |
$784.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.40
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.20
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Central Health Plan Commercial |
$784.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.40
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.20
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Central Health Plan Commercial |
$784.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.40
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.20
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$882.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$339.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$539.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$539.55
|
| 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 |
$588.60
|
| 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 |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Central Health Plan Commercial |
$784.80
|
| Rate for Payer: Cigna of CA HMO |
$627.84
|
| Rate for Payer: Cigna of CA PPO |
$725.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.85
|
| Rate for Payer: Dignity Health Media |
$833.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.40
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$735.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$343.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.21
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
| Rate for Payer: Riverside University Health System MISP |
$392.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$588.60
|
| 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 |
$833.85
|
| Rate for Payer: Vantage Medical Group Senior |
$833.85
|
|
