|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900407161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$148.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$194.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$308.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.25
|
| 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 |
$199.65
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$308.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$308.55
|
| Rate for Payer: Dignity Health Senior |
$308.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.70
|
| Rate for Payer: Heritage Provider Network Senior |
$224.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.10
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$308.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$308.55
|
| Rate for Payer: Vantage Medical Group Senior |
$308.55
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$148.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$194.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$308.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$272.25
|
| 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 |
$199.65
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$308.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$308.55
|
| Rate for Payer: Dignity Health Senior |
$308.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.70
|
| Rate for Payer: Heritage Provider Network Senior |
$224.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$254.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.10
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$308.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$308.55
|
| Rate for Payer: Vantage Medical Group Senior |
$308.55
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900417161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$385.90 |
| Rate for Payer: Adventist Health Commercial |
$186.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$242.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| 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 |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Senior |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.03
|
| Rate for Payer: Heritage Provider Network Senior |
$281.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| 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 |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$385.90 |
| Rate for Payer: Adventist Health Commercial |
$186.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$242.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| 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 |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Senior |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.03
|
| Rate for Payer: Heritage Provider Network Senior |
$281.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| 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 |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.36
|
| Rate for Payer: Heritage Provider Network Senior |
$307.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.36
|
| Rate for Payer: Heritage Provider Network Senior |
$307.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$385.90 |
| Rate for Payer: Adventist Health Commercial |
$186.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$242.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| 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 |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Senior |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.03
|
| Rate for Payer: Heritage Provider Network Senior |
$281.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| 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 |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$385.90 |
| Rate for Payer: Adventist Health Commercial |
$186.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$242.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| 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 |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Senior |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.03
|
| Rate for Payer: Heritage Provider Network Senior |
$281.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| 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 |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.36
|
| Rate for Payer: Heritage Provider Network Senior |
$307.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.36
|
| Rate for Payer: Heritage Provider Network Senior |
$307.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
IP
|
$413.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.60
|
| Rate for Payer: Heritage Provider Network Senior |
$279.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.25
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
|
OP
|
$413.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$169.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$220.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| 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 |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Senior |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.65
|
| Rate for Payer: Heritage Provider Network Senior |
$255.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$197.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
|
OP
|
$413.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$169.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$220.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| 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 |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Senior |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.65
|
| Rate for Payer: Heritage Provider Network Senior |
$255.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$197.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
|
IP
|
$413.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.60
|
| Rate for Payer: Heritage Provider Network Senior |
$279.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.25
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$92.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.50
|
| 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 |
$124.30
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.10
|
| Rate for Payer: Dignity Health Senior |
$192.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.89
|
| Rate for Payer: Heritage Provider Network Senior |
$139.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| 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 |
$192.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.10
|
| Rate for Payer: Vantage Medical Group Senior |
$192.10
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$92.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.50
|
| 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 |
$124.30
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.10
|
| Rate for Payer: Dignity Health Senior |
$192.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.89
|
| Rate for Payer: Heritage Provider Network Senior |
$139.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| 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 |
$192.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.10
|
| Rate for Payer: Vantage Medical Group Senior |
$192.10
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| 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 |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Senior |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| 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 |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Senior |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| 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 |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Senior |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
