|
HC OSMOLALITY URINE RANDOM
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.70
|
| Rate for Payer: Heritage Provider Network Senior |
$176.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
|
|
HC OSMOLALITY URINE RANDOM
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900912212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$139.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.31
|
| 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 |
$62.26
|
| Rate for Payer: Blue Shield of California Commercial |
$54.84
|
| Rate for Payer: Blue Shield of California EPN |
$43.98
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.65
|
| 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 |
$169.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.56
|
| Rate for Payer: Heritage Provider Network Senior |
$161.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| 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 |
$195.75
|
| 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
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.21
|
| 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 |
$61.03
|
| Rate for Payer: Blue Shield of California Commercial |
$53.80
|
| Rate for Payer: Blue Shield of California EPN |
$43.15
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: Dignity Health Senior |
$7.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Senior |
$87.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| 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 |
$105.75
|
| 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 |
$11.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.69
|
| 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 |
$121.94
|
| Rate for Payer: Blue Shield of California Commercial |
$107.48
|
| Rate for Payer: Blue Shield of California EPN |
$86.21
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.70
|
| 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 |
$245.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.98
|
| Rate for Payer: Heritage Provider Network Senior |
$233.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| 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 |
$283.50
|
| 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
|
$378.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.91
|
| Rate for Payer: Heritage Provider Network Senior |
$255.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
|
|
HC OS POUCH UROSTOMY 1 3/4"
|
Facility
|
IP
|
$2.96
|
|
| Hospital Charge Code |
901600679
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
HC OS POUCH UROSTOMY 1 3/4"
|
Facility
|
OP
|
$2.96
|
|
| Hospital Charge Code |
901600679
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
HC OTHER PT/OT CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8990
|
| Hospital Charge Code |
900018412
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8990
|
| Hospital Charge Code |
900018312
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC OTHER PT/OT CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8990
|
| Hospital Charge Code |
900018412
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC OTHER PT/OT CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8990
|
| Hospital Charge Code |
900018312
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8992
|
| Hospital Charge Code |
900018414
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8992
|
| Hospital Charge Code |
900018414
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC OTHER PT/OT D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8992
|
| Hospital Charge Code |
900018314
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC OTHER PT/OT D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8992
|
| Hospital Charge Code |
900018314
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8991
|
| Hospital Charge Code |
900018313
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC OTHER PT/OT GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8991
|
| Hospital Charge Code |
900018313
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8991
|
| Hospital Charge Code |
900018413
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC OTHER PT/OT GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8991
|
| Hospital Charge Code |
900018413
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.27
|
| Rate for Payer: Heritage Provider Network Senior |
$345.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
901397167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$209.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$350.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$382.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.50
|
| Rate for Payer: Dignity Health Senior |
$433.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.69
|
| Rate for Payer: Heritage Provider Network Senior |
$315.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$243.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.50
|
| Rate for Payer: Vantage Medical Group Senior |
$433.50
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$209.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$350.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$382.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.50
|
| Rate for Payer: Dignity Health Senior |
$433.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.69
|
| Rate for Payer: Heritage Provider Network Senior |
$315.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$243.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.50
|
| Rate for Payer: Vantage Medical Group Senior |
$433.50
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
905197167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.27
|
| Rate for Payer: Heritage Provider Network Senior |
$345.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
|
|
HC OT INIT EVAL HIGH
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 97167
|
| Hospital Charge Code |
908697167
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.27
|
| Rate for Payer: Heritage Provider Network Senior |
$345.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
|
