|
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: AlphaCare Medical Group Commercial/Exchange |
$681.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$441.10
|
| Rate for Payer: AlphaCare 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: 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
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: AlphaCare Medical Group Commercial/Exchange |
$295.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$191.40
|
| Rate for Payer: AlphaCare 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: 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: AlphaCare 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: 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: AlphaCare Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: AlphaCare 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
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/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: AlphaCare Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: AlphaCare 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: 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: AlphaCare 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: 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: AlphaCare 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: 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 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: AlphaCare Medical Group Commercial/Exchange |
$98.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: AlphaCare 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: 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
|
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 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: AlphaCare Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: AlphaCare 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: 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
|
|
|
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 W RADIOLOGY MCAL
|
Facility
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$239.64 |
| Max. Negotiated Rate |
$993.00 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$909.59
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.35
|
| Rate for Payer: Heritage Provider Network Senior |
$896.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.00
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$264.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$909.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,125.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$728.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$993.00
|
| 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 |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$860.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,125.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,125.40
|
| Rate for Payer: Dignity Health Senior |
$1,125.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$860.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$819.56
|
| Rate for Payer: Heritage Provider Network Senior |
$819.56
|
| Rate for Payer: IEHP Medi-Cal |
$62.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$638.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.00
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| 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 |
$1,125.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,125.40
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
IP
|
$510.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$350.37
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.27
|
| Rate for Payer: Heritage Provider Network Senior |
$345.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
OP
|
$510.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$227.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$350.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$382.50
|
| 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 |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.50
|
| Rate for Payer: Dignity Health Senior |
$433.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.69
|
| Rate for Payer: Heritage Provider Network Senior |
$315.69
|
| Rate for Payer: IEHP Medi-Cal |
$127.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$245.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| 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 |
$433.50
|
| Rate for Payer: Vantage Medical Group Senior |
$433.50
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.49 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,002.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,443.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,261.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,757.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,759.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,258.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,261.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,261.05
|
| Rate for Payer: Dignity Health Senior |
$4,261.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,103.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,103.05
|
| Rate for Payer: IEHP Medi-Cal |
$251.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,416.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.25
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,261.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,261.05
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$907.35 |
| Max. Negotiated Rate |
$3,759.75 |
| Rate for Payer: Adventist Health Commercial |
$1,002.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,443.93
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,393.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,393.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.25
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$907.35 |
| Max. Negotiated Rate |
$3,759.75 |
| Rate for Payer: Adventist Health Commercial |
$1,002.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,443.93
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,393.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,393.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.25
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
|
