|
HC EVAL REVAL FOR PRESCRIPT SPCH DEVICE
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
905601755
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.69
|
| Rate for Payer: Heritage Provider Network Senior |
$350.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
|
|
HC EVAL/REVAL FOR PRESCRIPT SPCH DEVICE MCAL
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
907000025
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$212.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$276.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$355.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.30
|
| Rate for Payer: Dignity Health Senior |
$440.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.64
|
| Rate for Payer: Heritage Provider Network Senior |
$320.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$247.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.60
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.30
|
| Rate for Payer: Vantage Medical Group Senior |
$440.30
|
|
|
HC EVAL/REVAL FOR PRESCRIPT SPCH DEVICE MCAL
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
907000025
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.69
|
| Rate for Payer: Heritage Provider Network Senior |
$350.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
|
|
HC EVAL RX SPEECH DVC 1ST HR MCAL
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
907000017
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
|
|
HC EVAL RX SPEECH DVC 1ST HR MCAL
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
907000017
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$268.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$345.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Senior |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.36
|
| Rate for Payer: Heritage Provider Network Senior |
$311.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$239.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC EVAL RX SPEECH DVC EA ADDL 30MIN MCAL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
907000019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC EVAL RX SPEECH DVC EA ADDL 30MIN MCAL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
907000019
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Senior |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$273.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Senior |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC EVAL SPEECH FLUENCY
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
900100000
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$288.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Senior |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Senior |
$334.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC EVAL SPEECH/LANGUAGE/VOICE PRELIM MCAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$273.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Senior |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC EVAL SPEECH SOUND PRODUCTION
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
900100001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$273.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Senior |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Senior |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Senior |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.56
|
| Rate for Payer: Heritage Provider Network Senior |
$495.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$64.72 |
| Max. Negotiated Rate |
$622.20 |
| Rate for Payer: Adventist Health Commercial |
$300.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$502.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$475.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: Dignity Health Senior |
$622.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.11
|
| Rate for Payer: Heritage Provider Network Senior |
$453.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$512.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$308.25 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.25
|
| Rate for Payer: Heritage Provider Network Senior |
$278.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.75
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$168.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$219.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$282.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$267.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Senior |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$254.41
|
| Rate for Payer: Heritage Provider Network Senior |
$254.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$196.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
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 |
$261.16 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,271.49
|
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| 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 HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,095.30
|
| 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 Senior |
$4,047.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,947.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,947.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,271.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.50
|
| 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: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 |
$861.92 |
| Max. Negotiated Rate |
$3,571.50 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Cash Price |
$2,619.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,223.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,223.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.50
|
| Rate for Payer: Multiplan Commercial |
$3,571.50
|
|
