|
ONDANSETRON HCL 8 MG TABLET [10779]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 57237-076-30
|
| Hospital Charge Code |
1711594
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
ONDANSETRON HCL 8 MG TABLET [10779]
|
Facility
IP
|
$0.76
|
|
|
Service Code
|
NDC 0904-6552-61
|
| Hospital Charge Code |
1711594
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.53
|
| Rate for Payer: Cigna of CA PPO |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [105614]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
1721066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [105614]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
1721066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.02
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
IP
|
$91,588.57
|
|
|
Service Code
|
APR-DRG 0214
|
| Min. Negotiated Rate |
$70,258.07 |
| Max. Negotiated Rate |
$91,588.57 |
| Rate for Payer: IEHP Medi-Cal |
$70,258.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91,588.57
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
IP
|
$30,824.52
|
|
|
Service Code
|
APR-DRG 0211
|
| Min. Negotiated Rate |
$23,645.65 |
| Max. Negotiated Rate |
$30,824.52 |
| Rate for Payer: IEHP Medi-Cal |
$23,645.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,824.52
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
IP
|
$39,237.81
|
|
|
Service Code
|
APR-DRG 0212
|
| Min. Negotiated Rate |
$30,099.53 |
| Max. Negotiated Rate |
$39,237.81 |
| Rate for Payer: IEHP Medi-Cal |
$30,099.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,237.81
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
IP
|
$58,703.29
|
|
|
Service Code
|
APR-DRG 0213
|
| Min. Negotiated Rate |
$45,031.61 |
| Max. Negotiated Rate |
$58,703.29 |
| Rate for Payer: IEHP Medi-Cal |
$45,031.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58,703.29
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
IP
|
$54,049.74
|
|
|
Service Code
|
APR-DRG 0203
|
| Min. Negotiated Rate |
$41,461.84 |
| Max. Negotiated Rate |
$54,049.74 |
| Rate for Payer: IEHP Medi-Cal |
$41,461.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,049.74
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
IP
|
$39,502.04
|
|
|
Service Code
|
APR-DRG 0202
|
| Min. Negotiated Rate |
$30,302.23 |
| Max. Negotiated Rate |
$39,502.04 |
| Rate for Payer: IEHP Medi-Cal |
$30,302.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,502.04
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
IP
|
$32,881.72
|
|
|
Service Code
|
APR-DRG 0201
|
| Min. Negotiated Rate |
$25,223.74 |
| Max. Negotiated Rate |
$32,881.72 |
| Rate for Payer: IEHP Medi-Cal |
$25,223.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32,881.72
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
IP
|
$84,498.28
|
|
|
Service Code
|
APR-DRG 0204
|
| Min. Negotiated Rate |
$64,819.08 |
| Max. Negotiated Rate |
$84,498.28 |
| Rate for Payer: IEHP Medi-Cal |
$64,819.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84,498.28
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
IP
|
$61,244.68
|
|
|
Service Code
|
APR-DRG 0244
|
| Min. Negotiated Rate |
$46,981.11 |
| Max. Negotiated Rate |
$61,244.68 |
| Rate for Payer: IEHP Medi-Cal |
$46,981.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,244.68
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
IP
|
$35,992.36
|
|
|
Service Code
|
APR-DRG 0243
|
| Min. Negotiated Rate |
$27,609.93 |
| Max. Negotiated Rate |
$35,992.36 |
| Rate for Payer: IEHP Medi-Cal |
$27,609.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,992.36
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
IP
|
$20,596.97
|
|
|
Service Code
|
APR-DRG 0242
|
| Min. Negotiated Rate |
$15,800.04 |
| Max. Negotiated Rate |
$20,596.97 |
| Rate for Payer: IEHP Medi-Cal |
$15,800.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,596.97
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
IP
|
$16,509.14
|
|
|
Service Code
|
APR-DRG 0241
|
| Min. Negotiated Rate |
$12,664.25 |
| Max. Negotiated Rate |
$16,509.14 |
| Rate for Payer: IEHP Medi-Cal |
$12,664.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,509.14
|
|
|
Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator
|
Facility
OP
|
$63,628.21
|
|
|
Service Code
|
CPT 64568
|
| Min. Negotiated Rate |
$1,044.81 |
| Max. Negotiated Rate |
$63,628.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38,797.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,713.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Dignity Health Media |
$38,797.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,677.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,376.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$38,797.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$63,628.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$63,628.21
|
| Rate for Payer: IEHP Medi-Cal |
$62,852.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$62,852.26
|
| Rate for Payer: IEHP Medicare Advantage |
$38,797.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,044.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,797.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,885.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,988.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Vantage Medical Group Senior |
$38,797.69
|
|
|
Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed
|
Facility
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 27814
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$14,480.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of clavicular fracture, includes internal fixation, when performed
|
Facility
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 23515
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$14,480.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only
|
Facility
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 27827
|
| Min. Negotiated Rate |
$343.79 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: IEHP Medi-Cal |
$26,639.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performed
|
Facility
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 24579
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: IEHP Medi-Cal |
$26,639.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed
|
Facility
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 24575
|
| Min. Negotiated Rate |
$720.80 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: IEHP Medi-Cal |
$26,639.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extension
|
Facility
OP
|
$26,968.11
|
|
|
Service Code
|
CPT 24545
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: IEHP Medi-Cal |
$26,639.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Open treatment of medial malleolus fracture, includes internal fixation, when performed
|
Facility
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 27766
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$14,480.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna
|
Facility
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 25575
|
| Min. Negotiated Rate |
$961.32 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$14,480.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
