|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900407163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$951.15 |
| Rate for Payer: Adventist Health Commercial |
$223.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$768.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$951.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$615.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.25
|
| 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 |
$503.55
|
| Rate for Payer: Cash Price |
$503.55
|
| Rate for Payer: Cash Price |
$503.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$727.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$951.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$951.15
|
| Rate for Payer: Dignity Health Senior |
$951.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$727.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.66
|
| Rate for Payer: Heritage Provider Network Senior |
$692.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$539.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.75
|
| Rate for Payer: Multiplan Commercial |
$839.25
|
| 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 |
$951.15
|
| Rate for Payer: Vantage Medical Group Senior |
$951.15
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$122.18 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.72
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.98
|
| Rate for Payer: Heritage Provider Network Senior |
$456.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
|
|
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 |
$100.00 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.29
|
| 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 |
$883.50
|
| 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 |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$765.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.30
|
| Rate for Payer: Dignity Health Senior |
$1,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.18
|
| Rate for Payer: Heritage Provider Network Senior |
$729.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$567.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| 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 |
$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 |
905197163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.29
|
| 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 |
$883.50
|
| 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 |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$765.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.30
|
| Rate for Payer: Dignity Health Senior |
$1,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.18
|
| Rate for Payer: Heritage Provider Network Senior |
$729.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$567.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| 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 |
$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 |
905197163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.29
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$797.51
|
| Rate for Payer: Heritage Provider Network Senior |
$797.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900407163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$202.54 |
| Max. Negotiated Rate |
$839.25 |
| Rate for Payer: Adventist Health Commercial |
$223.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$768.75
|
| Rate for Payer: Cash Price |
$503.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.56
|
| Rate for Payer: Heritage Provider Network Senior |
$757.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.75
|
| Rate for Payer: Multiplan Commercial |
$839.25
|
|
|
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 |
$213.22 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.29
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$797.51
|
| Rate for Payer: Heritage Provider Network Senior |
$797.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.25
|
| 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 |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$438.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.75
|
| Rate for Payer: Dignity Health Senior |
$573.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.82
|
| Rate for Payer: Heritage Provider Network Senior |
$417.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$325.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| 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 |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.46
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.97
|
| Rate for Payer: Heritage Provider Network Senior |
$303.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| 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 |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Senior |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.93
|
| Rate for Payer: Heritage Provider Network Senior |
$277.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| 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 |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.50
|
| 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 |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$634.10
|
| Rate for Payer: Dignity Health Senior |
$634.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| 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 |
$634.10
|
| Rate for Payer: Vantage Medical Group Senior |
$634.10
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.46
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.97
|
| Rate for Payer: Heritage Provider Network Senior |
$303.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$667.25 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.30
|
| 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 |
$588.75
|
| 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 |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$510.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$667.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$667.25
|
| Rate for Payer: Dignity Health Senior |
$667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$485.92
|
| Rate for Payer: Heritage Provider Network Senior |
$485.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$378.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.25
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
| 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 |
$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 |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$142.08 |
| Max. Negotiated Rate |
$588.75 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.30
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$531.44
|
| Rate for Payer: Heritage Provider Network Senior |
$531.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.25
|
| Rate for Payer: Multiplan Commercial |
$588.75
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| 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 |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Senior |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.93
|
| Rate for Payer: Heritage Provider Network Senior |
$277.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| 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 |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.47
|
| Rate for Payer: Heritage Provider Network Senior |
$380.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$477.70 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$477.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.50
|
| 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 |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$365.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$477.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$477.70
|
| Rate for Payer: Dignity Health Senior |
$477.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.88
|
| Rate for Payer: Heritage Provider Network Senior |
$347.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| 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 |
$477.70
|
| Rate for Payer: Vantage Medical Group Senior |
$477.70
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$477.70 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$477.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.50
|
| 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 |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$365.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$477.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$477.70
|
| Rate for Payer: Dignity Health Senior |
$477.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.88
|
| Rate for Payer: Heritage Provider Network Senior |
$347.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| 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 |
$477.70
|
| Rate for Payer: Vantage Medical Group Senior |
$477.70
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$177.56 |
| Max. Negotiated Rate |
$735.75 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.95
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.14
|
| Rate for Payer: Heritage Provider Network Senior |
$664.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.25
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.00
|
| 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 |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Senior |
$792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$576.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| 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 |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$833.85 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.95
|
| 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 |
$735.75
|
| 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 |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$637.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.85
|
| Rate for Payer: Dignity Health Senior |
$833.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$637.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$607.24
|
| Rate for Payer: Heritage Provider Network Senior |
$607.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$472.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.25
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| 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 |
$833.85
|
| Rate for Payer: Vantage Medical Group Senior |
$833.85
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.47
|
| Rate for Payer: Heritage Provider Network Senior |
$380.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
IP
|
$401.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
