|
HC EVAL SPEECH FLUENCY
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$128.97 |
| Max. Negotiated Rate |
$866.70 |
| Rate for Payer: Adventist Health Commercial |
$394.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$584.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Central Health Plan Commercial |
$770.40
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$866.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.97
|
| Rate for Payer: InnovAge PACE Commercial |
$481.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.10
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Riverside University Health System MISP |
$385.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.55
|
| Rate for Payer: Vantage Medical Group Senior |
$818.55
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$866.70 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Central Health Plan Commercial |
$770.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$866.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.60
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$893.70 |
| Rate for Payer: Adventist Health Commercial |
$407.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$844.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$546.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$744.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: Cigna of CA HMO |
$635.52
|
| Rate for Payer: Cigna of CA PPO |
$734.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$844.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$844.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$844.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$397.20
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$893.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.12
|
| Rate for Payer: InnovAge PACE Commercial |
$496.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$695.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$695.10
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
| Rate for Payer: Riverside University Health System MISP |
$397.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$595.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$844.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$844.05
|
| Rate for Payer: Vantage Medical Group Senior |
$844.05
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$893.70 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$397.20
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$893.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$317.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.60
|
| Rate for Payer: InnovAge PACE Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Riverside University Health System MISP |
$309.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$317.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$224.60
|
| Rate for Payer: InnovAge PACE Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Riverside University Health System MISP |
$309.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$375.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$404.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$598.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$739.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: Cigna of CA HMO |
$631.04
|
| Rate for Payer: Cigna of CA PPO |
$729.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.90
|
| Rate for Payer: InnovAge PACE Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
| Rate for Payer: Riverside University Health System MISP |
$394.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$591.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$591.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.10
|
| Rate for Payer: Vantage Medical Group Senior |
$838.10
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$197.20
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$375.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Adventist Health Commercial |
$404.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$598.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$739.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Central Health Plan Commercial |
$788.80
|
| Rate for Payer: Cigna of CA HMO |
$631.04
|
| Rate for Payer: Cigna of CA PPO |
$729.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Senior |
$394.40
|
| Rate for Payer: Galaxy Health WC |
$838.10
|
| Rate for Payer: Global Benefits Group Commercial |
$591.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$887.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.90
|
| Rate for Payer: InnovAge PACE Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.20
|
| Rate for Payer: Multiplan Commercial |
$739.50
|
| Rate for Payer: Networks By Design Commercial |
$640.90
|
| Rate for Payer: Prime Health Services Commercial |
$838.10
|
| Rate for Payer: Riverside University Health System MISP |
$394.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$591.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$591.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.10
|
| Rate for Payer: Vantage Medical Group Senior |
$838.10
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$1,073.70 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Central Health Plan Commercial |
$954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.20
|
| Rate for Payer: EPIC Health Plan Senior |
$477.20
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,073.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$738.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.60
|
| Rate for Payer: Multiplan Commercial |
$894.75
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$1,073.70 |
| Rate for Payer: Adventist Health Commercial |
$489.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$724.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,014.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$656.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$894.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Central Health Plan Commercial |
$954.40
|
| Rate for Payer: Cigna of CA HMO |
$763.52
|
| Rate for Payer: Cigna of CA PPO |
$882.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,014.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,014.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,014.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.20
|
| Rate for Payer: EPIC Health Plan Senior |
$477.20
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,073.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.71
|
| Rate for Payer: InnovAge PACE Commercial |
$596.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$738.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$835.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$835.10
|
| Rate for Payer: Multiplan Commercial |
$894.75
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
| Rate for Payer: Riverside University Health System MISP |
$477.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,014.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,014.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,014.05
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Adventist Health Commercial |
$171.60
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$643.50
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$140.85 |
| Max. Negotiated Rate |
$772.20 |
| Rate for Payer: Adventist Health Commercial |
$351.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$521.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$643.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Central Health Plan Commercial |
$686.40
|
| Rate for Payer: Cigna of CA HMO |
$549.12
|
| Rate for Payer: Cigna of CA PPO |
$634.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$729.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$729.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$729.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$343.20
|
| Rate for Payer: Galaxy Health WC |
$729.30
|
| Rate for Payer: Global Benefits Group Commercial |
$514.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$772.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.85
|
| Rate for Payer: InnovAge PACE Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$600.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$643.50
|
| Rate for Payer: Networks By Design Commercial |
$557.70
|
| Rate for Payer: Prime Health Services Commercial |
$729.30
|
| Rate for Payer: Riverside University Health System MISP |
$343.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$729.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$729.30
|
| Rate for Payer: Vantage Medical Group Senior |
$729.30
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$3,643.20 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,542.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,505.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.28 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,619.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,571.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,809.60
|
| Rate for Payer: Cigna of CA HMO |
$3,047.68
|
| Rate for Payer: Cigna of CA PPO |
$3,523.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,047.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,047.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,285.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,381.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,333.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,333.40
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,904.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,857.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.40 |
| Max. Negotiated Rate |
$4,285.80 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,285.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.40
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.28 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,036.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Cigna of CA HMO |
$2,590.72
|
| Rate for Payer: Cigna of CA PPO |
$2,995.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2,024.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,505.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,833.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,833.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,619.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,619.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,571.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,809.60
|
| Rate for Payer: Cigna of CA HMO |
$3,047.68
|
| Rate for Payer: Cigna of CA PPO |
$3,523.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,047.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,047.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,285.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.62
|
| Rate for Payer: InnovAge PACE Commercial |
$2,381.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,333.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,333.40
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,904.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,857.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$3,643.20 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,542.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,505.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.40 |
| Max. Negotiated Rate |
$4,285.80 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,285.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.40
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,036.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Cigna of CA HMO |
$2,590.72
|
| Rate for Payer: Cigna of CA PPO |
$2,995.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.62
|
| Rate for Payer: InnovAge PACE Commercial |
$2,024.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,505.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,833.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,833.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,619.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC EVEROLIMUS B
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.19
|
| Rate for Payer: Blue Shield of California Commercial |
$53.42
|
| Rate for Payer: Blue Shield of California EPN |
$34.94
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Senior |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: InnovAge PACE Commercial |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
