|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$467.25 |
| Rate for Payer: Adventist Health Commercial |
$124.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.00
|
| Rate for Payer: Cash Price |
$280.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$421.77
|
| Rate for Payer: Heritage Provider Network Senior |
$421.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.75
|
| Rate for Payer: Multiplan Commercial |
$467.25
|
|
|
HC EVAL OF SWALLOW W/RADIOLOGY
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
905601754
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$770.10 |
| Rate for Payer: Adventist Health Commercial |
$181.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$264.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$622.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$679.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$588.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.10
|
| Rate for Payer: Dignity Health Senior |
$770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$560.81
|
| Rate for Payer: Heritage Provider Network Senior |
$560.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$679.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.10
|
| Rate for Payer: Vantage Medical Group Senior |
$770.10
|
|
|
HC EVAL OF SWALLOW W/RADIOLOGY
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
905601754
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$163.99 |
| Max. Negotiated Rate |
$679.50 |
| Rate for Payer: Adventist Health Commercial |
$181.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$622.42
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$613.36
|
| Rate for Payer: Heritage Provider Network Senior |
$613.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$679.50
|
|
|
HC EVAL REVAL FOR PRESCRIPT SPCH DEVICE
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
905601755
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$544.85 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$544.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$352.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$416.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$544.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$544.85
|
| Rate for Payer: Dignity Health Senior |
$544.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.78
|
| Rate for Payer: Heritage Provider Network Senior |
$396.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$308.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$544.85
|
| Rate for Payer: Vantage Medical Group Senior |
$544.85
|
|
|
HC EVAL REVAL FOR PRESCRIPT SPCH DEVICE
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
905601755
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.37
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.96
|
| Rate for Payer: Heritage Provider Network Senior |
$433.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
|
|
HC EVAL/REVAL FOR PRESCRIPT SPCH DEVICE MCAL
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
907000025
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$110.41 |
| Max. Negotiated Rate |
$457.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.07
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.97
|
| Rate for Payer: Heritage Provider Network Senior |
$412.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.50
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
|
|
HC EVAL/REVAL FOR PRESCRIPT SPCH DEVICE MCAL
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
907000025
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$396.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Senior |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$377.59
|
| Rate for Payer: Heritage Provider Network Senior |
$377.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$294.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.50
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC EVAL RX SPEECH DVC 1ST HR MCAL
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
907000017
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$681.70 |
| Rate for Payer: Adventist Health Commercial |
$160.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$412.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$681.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$441.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$601.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$521.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$681.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.70
|
| Rate for Payer: Dignity Health Senior |
$681.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.44
|
| Rate for Payer: Heritage Provider Network Senior |
$496.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$386.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.50
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.70
|
| Rate for Payer: Vantage Medical Group Senior |
$681.70
|
|
|
HC EVAL RX SPEECH DVC 1ST HR MCAL
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
907000017
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$601.50 |
| Rate for Payer: Adventist Health Commercial |
$160.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.97
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.95
|
| Rate for Payer: Heritage Provider Network Senior |
$542.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.50
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
|
|
HC EVAL RX SPEECH DVC EA ADDL 30MIN MCAL
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
907000019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.08
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.60
|
| Rate for Payer: Heritage Provider Network Senior |
$235.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
|
|
HC EVAL RX SPEECH DVC EA ADDL 30MIN MCAL
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
907000019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$29.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$295.80
|
| Rate for Payer: Dignity Health Senior |
$295.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.41
|
| Rate for Payer: Heritage Provider Network Senior |
$215.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$167.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$295.80
|
| Rate for Payer: Vantage Medical Group Senior |
$295.80
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$116.97 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.91
|
| Rate for Payer: Heritage Provider Network Senior |
$511.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$398.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE MCARE COMM
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT 92506
|
| Hospital Charge Code |
905601001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$542.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$697.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$659.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Senior |
$862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.28
|
| Rate for Payer: Heritage Provider Network Senior |
$628.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$489.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.75
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE MCARE COMM
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT 92506
|
| Hospital Charge Code |
905601001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$183.72 |
| Max. Negotiated Rate |
$761.25 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$697.30
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$687.16
|
| Rate for Payer: Heritage Provider Network Senior |
$687.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.75
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.05
|
| Rate for Payer: Dignity Health Senior |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.71
|
| Rate for Payer: Heritage Provider Network Senior |
$94.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.05
|
| Rate for Payer: Vantage Medical Group Senior |
$130.05
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.11
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$183.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.91
|
| Rate for Payer: Heritage Provider Network Senior |
$511.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$398.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$382.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.91
|
| Rate for Payer: Heritage Provider Network Senior |
$511.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$398.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$75.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.60
|
| Rate for Payer: Dignity Health Senior |
$98.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.80
|
| Rate for Payer: Heritage Provider Network Senior |
$71.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.60
|
| Rate for Payer: Vantage Medical Group Senior |
$98.60
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$198.20 |
| Max. Negotiated Rate |
$821.25 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$752.26
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$741.32
|
| Rate for Payer: Heritage Provider Network Senior |
$741.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.75
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$76.10 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$752.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$711.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Senior |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$677.80
|
| Rate for Payer: Heritage Provider Network Senior |
$677.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$527.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.75
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
