|
HC PTCA SINGLER VESSEL
|
Facility
OP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$18,891.75 |
| Rate for Payer: Adventist Health Commercial |
$5,037.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,184.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,304.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,591.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$678.79
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,559.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,297.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
IP
|
$18,226.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,298.91 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
OP
|
$18,226.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,184.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,281.89
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$678.79
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
IP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,559.21 |
| Max. Negotiated Rate |
$18,891.75 |
| Rate for Payer: Adventist Health Commercial |
$5,037.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,304.84
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,559.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,297.25
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN OT
|
Facility
OP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905104212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$214.50
|
| 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 |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: Dignity Health Senior |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.03
|
| Rate for Payer: Heritage Provider Network Senior |
$177.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| 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 |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN OT
|
Facility
IP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905104212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.62
|
| Rate for Payer: Heritage Provider Network Senior |
$193.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN PT
|
Facility
OP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905103212
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$214.50
|
| 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 |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: Dignity Health Senior |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.03
|
| Rate for Payer: Heritage Provider Network Senior |
$177.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| 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 |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN PT
|
Facility
IP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905103212
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.62
|
| Rate for Payer: Heritage Provider Network Senior |
$193.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
IP
|
$345.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.02
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.56
|
| Rate for Payer: Heritage Provider Network Senior |
$233.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
OP
|
$345.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$293.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$189.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$258.75
|
| 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 |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.25
|
| Rate for Payer: Dignity Health Senior |
$293.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.56
|
| Rate for Payer: Heritage Provider Network Senior |
$213.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| 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 |
$293.25
|
| Rate for Payer: Vantage Medical Group Senior |
$293.25
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1,001.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$647.90
|
| Rate for Payer: AlphaCare 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: 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 |
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
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
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: AlphaCare Medical Group Commercial/Exchange |
$1,001.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$647.90
|
| Rate for Payer: AlphaCare 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: 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
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: AlphaCare Medical Group Commercial/Exchange |
$951.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$615.45
|
| Rate for Payer: AlphaCare 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: 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: AlphaCare 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: 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
|
$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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$667.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.75
|
| Rate for Payer: AlphaCare 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
|
$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
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: AlphaCare Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: AlphaCare 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: AlphaCare 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
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
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
|
|
