|
HC PT INIT EVAL LOW
|
Facility
OP
|
$746.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
905197161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$410.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$559.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$634.10
|
| Rate for Payer: Dignity Health Senior |
$634.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$634.10
|
| Rate for Payer: Vantage Medical Group Senior |
$634.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
OP
|
$932.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$699.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Senior |
$792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$576.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$449.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.47
|
| Rate for Payer: Heritage Provider Network Senior |
$380.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
IP
|
$932.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
905197162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
IP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$177.56 |
| Max. Negotiated Rate |
$735.75 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.95
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.14
|
| Rate for Payer: Heritage Provider Network Senior |
$664.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.25
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900407162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$477.70 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$477.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$309.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$421.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$365.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$477.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$477.70
|
| Rate for Payer: Dignity Health Senior |
$477.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.88
|
| Rate for Payer: Heritage Provider Network Senior |
$347.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$477.70
|
| Rate for Payer: Vantage Medical Group Senior |
$477.70
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$477.70 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$477.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$309.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$421.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$365.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$477.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$477.70
|
| Rate for Payer: Dignity Health Senior |
$477.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.88
|
| Rate for Payer: Heritage Provider Network Senior |
$347.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$477.70
|
| Rate for Payer: Vantage Medical Group Senior |
$477.70
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
OP
|
$981.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900417162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$833.85 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$833.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$539.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$735.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cash Price |
$441.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$637.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.85
|
| Rate for Payer: Dignity Health Senior |
$833.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$637.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$607.24
|
| Rate for Payer: Heritage Provider Network Senior |
$607.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$472.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.25
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$833.85
|
| Rate for Payer: Vantage Medical Group Senior |
$833.85
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.47
|
| Rate for Payer: Heritage Provider Network Senior |
$380.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
OP
|
$401.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$300.75
|
| 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 |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Senior |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.22
|
| Rate for Payer: Heritage Provider Network Senior |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$193.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| 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 |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF
|
Facility
IP
|
$401.00
|
|
| Hospital Charge Code |
905103349
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
OP
|
$401.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$300.75
|
| 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 |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Senior |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.22
|
| Rate for Payer: Heritage Provider Network Senior |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$193.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| 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 |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC PT PRELIM EVAL FOR REHAB SNF ICF MCAL
|
Facility
IP
|
$401.00
|
|
| Hospital Charge Code |
900419049
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
|
HC PT RE-EVALUATION
|
Facility
OP
|
$280.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Senior |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: IEHP Medi-Cal |
$146.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC PT RE-EVALUATION
|
Facility
IP
|
$280.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
IP
|
$280.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC PT RE-EVALUATION COMM MCARE
|
Facility
OP
|
$280.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900419008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Senior |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: IEHP Medi-Cal |
$146.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC PT RE-EVALUATION MCAL
|
Facility
IP
|
$542.00
|
|
|
Service Code
|
CPT 97002
|
| Hospital Charge Code |
900400034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Adventist Health Commercial |
$108.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$372.35
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.93
|
| Rate for Payer: Heritage Provider Network Senior |
$366.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.50
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
|
|
HC PT RE-EVALUATION MCAL
|
Facility
OP
|
$542.00
|
|
|
Service Code
|
CPT 97002
|
| Hospital Charge Code |
900400034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$460.70 |
| Rate for Payer: Adventist Health Commercial |
$108.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$289.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$372.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$460.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$298.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$406.50
|
| 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 |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$460.70
|
| Rate for Payer: Dignity Health Senior |
$460.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.50
|
| Rate for Payer: Heritage Provider Network Senior |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.50
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| 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 |
$460.70
|
| Rate for Payer: Vantage Medical Group Senior |
$460.70
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
OP
|
$184.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Senior |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN
|
Facility
IP
|
$184.00
|
|
| Hospital Charge Code |
905103300
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
IP
|
$184.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC PT SINGLE MODALITY INITIAL 30 MIN MCAL
|
Facility
OP
|
$184.00
|
|
| Hospital Charge Code |
900419011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Senior |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
IP
|
$98.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN
|
Facility
OP
|
$98.00
|
|
| Hospital Charge Code |
905103301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.50
|
| 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 |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Senior |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| 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 |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
