|
HC EVAL/REVAL FOR PRESCRIPT SPCH DEVICE MCAL
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
907000025
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$479.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$369.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$479.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$338.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna of CA HMO |
$360.96
|
| Rate for Payer: Cigna of CA PPO |
$417.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$479.40
|
| Rate for Payer: Dignity Health Media |
$479.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$479.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.36
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$479.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$479.40
|
| Rate for Payer: Vantage Medical Group Senior |
$479.40
|
|
|
HC EVAL RX SPEECH DVC 1ST HR MCAL
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
907000017
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.80
|
| Rate for Payer: Galaxy Health WC |
$630.70
|
| Rate for Payer: Global Benefits Group Commercial |
$445.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.08
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: Networks By Design Commercial |
$482.30
|
| Rate for Payer: Prime Health Services Commercial |
$630.70
|
|
|
HC EVAL RX SPEECH DVC 1ST HR MCAL
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
907000017
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$178.08 |
| Max. Negotiated Rate |
$1,179.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,179.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$630.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$408.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$445.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO |
$474.88
|
| Rate for Payer: Cigna of CA PPO |
$549.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.70
|
| Rate for Payer: Dignity Health Media |
$630.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$296.80
|
| Rate for Payer: Galaxy Health WC |
$630.70
|
| Rate for Payer: Global Benefits Group Commercial |
$445.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$556.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.08
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: Networks By Design Commercial |
$482.30
|
| Rate for Payer: Prime Health Services Commercial |
$630.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$445.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$630.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$630.70
|
| Rate for Payer: Vantage Medical Group Senior |
$630.70
|
|
|
HC EVAL RX SPEECH DVC EA ADDL 30MIN MCAL
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
907000019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC EVAL RX SPEECH DVC EA ADDL 30MIN MCAL
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
907000019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$346.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$193.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$273.70
|
| Rate for Payer: Dignity Health Media |
$273.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$273.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.70
|
| Rate for Payer: Vantage Medical Group Senior |
$273.70
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.20
|
| Rate for Payer: Galaxy Health WC |
$839.80
|
| Rate for Payer: Global Benefits Group Commercial |
$592.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.12
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: Networks By Design Commercial |
$642.20
|
| Rate for Payer: Prime Health Services Commercial |
$839.80
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$648.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$839.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$543.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$592.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna of CA HMO |
$632.32
|
| Rate for Payer: Cigna of CA PPO |
$731.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$839.80
|
| Rate for Payer: Dignity Health Media |
$839.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$395.20
|
| Rate for Payer: Galaxy Health WC |
$839.80
|
| Rate for Payer: Global Benefits Group Commercial |
$592.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$741.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.12
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: Networks By Design Commercial |
$642.20
|
| Rate for Payer: Prime Health Services Commercial |
$839.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$592.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$592.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$839.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$839.80
|
| Rate for Payer: Vantage Medical Group Senior |
$839.80
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$244.56 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$458.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$560.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$611.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cigna of CA HMO |
$652.16
|
| Rate for Payer: Cigna of CA PPO |
$754.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Media |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$764.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$525.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Media |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$1,092.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,092.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Media |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$452.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$557.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$607.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.05
|
| Rate for Payer: Dignity Health Media |
$861.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$759.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.05
|
| Rate for Payer: Vantage Medical Group Senior |
$861.05
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$452.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$557.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$607.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.05
|
| Rate for Payer: Dignity Health Media |
$861.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$759.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.05
|
| Rate for Payer: Vantage Medical Group Senior |
$861.05
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,041.25 |
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.00
|
| Rate for Payer: Galaxy Health WC |
$1,041.25
|
| Rate for Payer: Global Benefits Group Commercial |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$980.00
|
| Rate for Payer: Networks By Design Commercial |
$796.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,041.25
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$1,041.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$755.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,041.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$673.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$673.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$735.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: Cash Price |
$551.25
|
| Rate for Payer: Cigna of CA HMO |
$784.00
|
| Rate for Payer: Cigna of CA PPO |
$906.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,041.25
|
| Rate for Payer: Dignity Health Media |
$1,041.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,041.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.00
|
| Rate for Payer: Galaxy Health WC |
$1,041.25
|
| Rate for Payer: Global Benefits Group Commercial |
$735.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$918.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$980.00
|
| Rate for Payer: Networks By Design Commercial |
$796.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,041.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$735.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$735.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,041.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,041.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,041.25
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$211.44 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$155.59 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$649.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$484.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.85
|
| Rate for Payer: Dignity Health Media |
$748.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$660.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.85
|
| Rate for Payer: Vantage Medical Group Senior |
$748.85
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,203.12 |
| Max. Negotiated Rate |
$4,261.05 |
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,203.12
|
| Rate for Payer: Multiplan Commercial |
$4,010.40
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.30 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,049.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,007.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Media |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,759.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,203.12
|
| Rate for Payer: Multiplan Commercial |
$4,010.40
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,203.12 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,813.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,007.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cigna of CA PPO |
$3,709.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Media |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,759.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,203.12
|
| Rate for Payer: Multiplan Commercial |
$4,010.40
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,203.12 |
| Max. Negotiated Rate |
$4,261.05 |
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,203.12
|
| Rate for Payer: Multiplan Commercial |
$4,010.40
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
