|
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 |
900417162
|
|
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 |
905197162
|
|
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 PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
OP
|
$537.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$483.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$326.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$295.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.35
|
| 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 |
$322.20
|
| 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 |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Central Health Plan Commercial |
$429.60
|
| Rate for Payer: Cigna of CA HMO |
$343.68
|
| Rate for Payer: Cigna of CA PPO |
$397.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.45
|
| Rate for Payer: Dignity Health Media |
$456.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$456.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$214.80
|
| Rate for Payer: Galaxy Health WC |
$456.45
|
| Rate for Payer: Global Benefits Group Commercial |
$322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$483.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$402.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.17
|
| Rate for Payer: Multiplan Commercial |
$402.75
|
| Rate for Payer: Networks By Design Commercial |
$349.05
|
| Rate for Payer: Prime Health Services Commercial |
$456.45
|
| Rate for Payer: Riverside University Health System MISP |
$214.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.20
|
| 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 |
$456.45
|
| Rate for Payer: Vantage Medical Group Senior |
$456.45
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
IP
|
$537.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$483.30 |
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Central Health Plan Commercial |
$429.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.80
|
| Rate for Payer: Galaxy Health WC |
$456.45
|
| Rate for Payer: Global Benefits Group Commercial |
$322.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$483.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.40
|
| Rate for Payer: Multiplan Commercial |
$402.75
|
| Rate for Payer: Networks By Design Commercial |
$349.05
|
| Rate for Payer: Prime Health Services Commercial |
$456.45
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$524.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$495.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.65
|
| 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 |
$349.80
|
| 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 |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$495.55
|
| Rate for Payer: Dignity Health Media |
$495.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$495.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$437.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.03
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Riverside University Health System MISP |
$233.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| 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 |
$495.55
|
| Rate for Payer: Vantage Medical Group Senior |
$495.55
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$524.70 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.60
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC PT PRELIMINARY EVALUATION
|
Facility
|
IP
|
$444.00
|
|
| Hospital Charge Code |
903200136
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Central Health Plan Commercial |
$355.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$399.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
|
|
HC PT PRELIMINARY EVALUATION
|
Facility
|
OP
|
$444.00
|
|
| Hospital Charge Code |
903200136
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$269.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$377.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.20
|
| 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 |
$266.40
|
| 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 |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Central Health Plan Commercial |
$355.20
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$377.40
|
| Rate for Payer: Dignity Health Media |
$377.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$377.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$399.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$333.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$155.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.04
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Riverside University Health System MISP |
$177.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| 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 |
$377.40
|
| Rate for Payer: Vantage Medical Group Senior |
$377.40
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Central Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.20
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$228.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.80
|
| 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 |
$297.60
|
| 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 |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Central Health Plan Commercial |
$396.80
|
| Rate for Payer: Cigna of CA HMO |
$317.44
|
| Rate for Payer: Cigna of CA PPO |
$367.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.60
|
| Rate for Payer: Dignity Health Media |
$421.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$446.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$372.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.36
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
| Rate for Payer: Riverside University Health System MISP |
$198.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$297.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$297.60
|
| 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 |
$421.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.60
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Central Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.20
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$228.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.80
|
| 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 |
$297.60
|
| 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 |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Central Health Plan Commercial |
$396.80
|
| Rate for Payer: Cigna of CA HMO |
$317.44
|
| Rate for Payer: Cigna of CA PPO |
$367.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.60
|
| Rate for Payer: Dignity Health Media |
$421.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$446.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$372.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.36
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
| Rate for Payer: Riverside University Health System MISP |
$198.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$297.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$297.60
|
| 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 |
$421.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.60
|
|
|
HC PT RE-EVALUATION MCAL
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 97002
|
| Hospital Charge Code |
900400034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$329.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$298.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.10
|
| 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 |
$325.20
|
| 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 |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Central Health Plan Commercial |
$433.60
|
| Rate for Payer: Cigna of CA HMO |
$346.88
|
| Rate for Payer: Cigna of CA PPO |
$401.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.70
|
| Rate for Payer: Dignity Health Media |
$460.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$460.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$406.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.22
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
| Rate for Payer: Riverside University Health System MISP |
$216.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.20
|
| 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 |
$460.70
|
| Rate for Payer: Vantage Medical Group Senior |
$460.70
|
|
|
HC PT RE-EVALUATION MCAL
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 97002
|
| Hospital Charge Code |
900400034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Central Health Plan Commercial |
$433.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.80
|
| Rate for Payer: Galaxy Health WC |
$460.70
|
| Rate for Payer: Global Benefits Group Commercial |
$325.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.40
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: Networks By Design Commercial |
$352.30
|
| Rate for Payer: Prime Health Services Commercial |
$460.70
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.20
|
| 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 |
$110.40
|
| 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 |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Media |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| 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 |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.20
|
| 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 |
$110.40
|
| 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 |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Media |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| 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 |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.90
|
| 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 |
$58.80
|
| 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 |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Media |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.18
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Riverside University Health System MISP |
$39.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
900419012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
900419012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.90
|
| 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 |
$58.80
|
| 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 |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Media |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.18
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Riverside University Health System MISP |
$39.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
905103303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
905103303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.90
|
| 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 |
$58.80
|
| 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 |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Media |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.18
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Riverside University Health System MISP |
$39.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| 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 |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
