|
HC OSMOLALITY URINE
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.13
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.77
|
| Rate for Payer: Heritage Provider Network Senior |
$159.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.08
|
| Rate for Payer: Blue Shield of California Commercial |
$53.22
|
| Rate for Payer: Blue Shield of California EPN |
$41.60
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.59
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE 24 HOURS
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.13
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.77
|
| Rate for Payer: Heritage Provider Network Senior |
$159.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
|
|
HC OSMOLALITY URINE 24 HOURS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.08
|
| Rate for Payer: Blue Shield of California Commercial |
$53.22
|
| Rate for Payer: Blue Shield of California EPN |
$41.60
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.59
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE RANDOM
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.13
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.77
|
| Rate for Payer: Heritage Provider Network Senior |
$159.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
|
|
HC OSMOLALITY URINE RANDOM
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$57.08 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.08
|
| Rate for Payer: Blue Shield of California Commercial |
$53.22
|
| Rate for Payer: Blue Shield of California EPN |
$41.60
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.59
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$55.96 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.96
|
| Rate for Payer: Blue Shield of California Commercial |
$52.21
|
| Rate for Payer: Blue Shield of California EPN |
$40.82
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: Dignity Health Senior |
$7.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Humana Medicare |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.47
|
| Rate for Payer: TriValley Medical Group Senior |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.80
|
| Rate for Payer: Blue Shield of California Commercial |
$104.31
|
| Rate for Payer: Blue Shield of California EPN |
$81.54
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.70
|
| Rate for Payer: Dignity Health Senior |
$13.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Humana Medicare |
$13.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.83
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.36
|
| Rate for Payer: TriValley Medical Group Senior |
$13.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Vantage Medical Group Senior |
$13.36
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.45
|
| Rate for Payer: Heritage Provider Network Senior |
$269.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$844.05 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$682.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$844.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$546.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$744.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$645.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$844.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$844.05
|
| Rate for Payer: Dignity Health Senior |
$844.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$614.67
|
| Rate for Payer: Heritage Provider Network Senior |
$614.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$478.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.25
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$844.05
|
| Rate for Payer: Vantage Medical Group Senior |
$844.05
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$537.20 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$347.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$410.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.20
|
| Rate for Payer: Dignity Health Senior |
$537.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.21
|
| Rate for Payer: Heritage Provider Network Senior |
$391.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$304.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.00
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.20
|
| Rate for Payer: Vantage Medical Group Senior |
$537.20
|
|
|
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 |
$100.00 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Adventist Health Commercial |
$209.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$717.92
|
| 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 |
$783.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$679.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$888.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$888.25
|
| Rate for Payer: Dignity Health Senior |
$888.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$646.86
|
| Rate for Payer: Heritage Provider Network Senior |
$646.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$503.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.25
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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
|
$993.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$179.73 |
| Max. Negotiated Rate |
$744.75 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$682.19
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.26
|
| Rate for Payer: Heritage Provider Network Senior |
$672.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.25
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
|
|
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 |
$189.14 |
| Max. Negotiated Rate |
$783.75 |
| Rate for Payer: Adventist Health Commercial |
$209.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$717.92
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$707.46
|
| Rate for Payer: Heritage Provider Network Senior |
$707.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.25
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$114.39 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.18
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.86
|
| Rate for Payer: Heritage Provider Network Senior |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.00
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
908697165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$592.45 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$478.84
|
| 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 |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Dignity Health Senior |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.44
|
| Rate for Payer: Heritage Provider Network Senior |
$431.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$335.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.25
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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 |
$126.16 |
| Max. Negotiated Rate |
$522.75 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$478.84
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.87
|
| Rate for Payer: Heritage Provider Network Senior |
$471.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.25
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
901397165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$315.75 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.23
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.02
|
| Rate for Payer: Heritage Provider Network Senior |
$285.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$315.75
|
|
|
HC OT INIT EVAL LOW
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 97165
|
| Hospital Charge Code |
901397165
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$357.85 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$273.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.85
|
| Rate for Payer: Dignity Health Senior |
$357.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.60
|
| Rate for Payer: Heritage Provider Network Senior |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$202.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$315.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.85
|
| Rate for Payer: Vantage Medical Group Senior |
$357.85
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Senior |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Senior |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.04
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.30
|
| Rate for Payer: Heritage Provider Network Senior |
$456.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
|
