|
Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning
|
Facility
OP
|
$13,086.00
|
|
|
Service Code
|
CPT 27178
|
| Min. Negotiated Rate |
$311.24 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.24
|
|
|
Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed
|
Facility
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 27535
|
| Min. Negotiated Rate |
$225.64 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.64
|
|
|
Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip
|
Facility
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 27822
|
| Min. Negotiated Rate |
$1,492.54 |
| 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 |
$1,492.54
|
| 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
|
|
|
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 92018
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$903.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| Rate for Payer: IEHP Medi-Cal |
$4,729.87
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,729.87
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 92019
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$435.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| Rate for Payer: IEHP Medi-Cal |
$4,729.87
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,729.87
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
IP
|
$26,293.32
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$20,169.74 |
| Max. Negotiated Rate |
$26,293.32 |
| Rate for Payer: IEHP Medi-Cal |
$20,169.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,293.32
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
IP
|
$6,414.61
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$4,920.68 |
| Max. Negotiated Rate |
$6,414.61 |
| Rate for Payer: IEHP Medi-Cal |
$4,920.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,414.61
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
IP
|
$4,492.17
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$3,445.97 |
| Max. Negotiated Rate |
$4,492.17 |
| Rate for Payer: IEHP Medi-Cal |
$3,445.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,492.17
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
IP
|
$11,903.46
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$9,131.21 |
| Max. Negotiated Rate |
$11,903.46 |
| Rate for Payer: IEHP Medi-Cal |
$9,131.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,903.46
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
OP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: BCBS Transplant Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Media |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
IP
|
$6.28
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
NDG99405
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
IP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Blue Shield of California Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL [99405]
|
Facility
OP
|
$6.28
|
|
|
Service Code
|
NDC 9999-9994-05
|
| Hospital Charge Code |
1715201
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.74
|
| Rate for Payer: BCBS Transplant Transplant |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$4.40
|
| Rate for Payer: Cigna of CA PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.34
|
| Rate for Payer: Dignity Health Media |
$5.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.51
|
| Rate for Payer: Galaxy Health WC |
$5.34
|
| Rate for Payer: Global Benefits Group Commercial |
$3.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$5.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other HMO |
$3.14
|
| Rate for Payer: United Healthcare HMO Rider |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.34
|
| Rate for Payer: Vantage Medical Group Senior |
$5.34
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$28,260.09
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$21,678.46 |
| Max. Negotiated Rate |
$28,260.09 |
| Rate for Payer: IEHP Medi-Cal |
$21,678.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,260.09
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$54,510.85
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$41,815.56 |
| Max. Negotiated Rate |
$54,510.85 |
| Rate for Payer: IEHP Medi-Cal |
$41,815.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,510.85
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$14,226.69
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$10,913.37 |
| Max. Negotiated Rate |
$14,226.69 |
| Rate for Payer: IEHP Medi-Cal |
$10,913.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,226.69
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
IP
|
$18,059.14
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$13,853.26 |
| Max. Negotiated Rate |
$18,059.14 |
| Rate for Payer: IEHP Medi-Cal |
$13,853.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,059.14
|
|
|
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
|
Facility
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 54520
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: IEHP Medi-Cal |
$7,056.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Orchiopexy, inguinal or scrotal approach
|
Facility
OP
|
$12,491.00
|
|
|
Service Code
|
CPT 54640
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: IEHP Medi-Cal |
$7,002.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$7,028.21
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$5,391.38 |
| Max. Negotiated Rate |
$7,028.21 |
| Rate for Payer: IEHP Medi-Cal |
$5,391.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,028.21
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$33,555.63
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$25,740.70 |
| Max. Negotiated Rate |
$33,555.63 |
| Rate for Payer: IEHP Medi-Cal |
$25,740.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,555.63
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$14,540.60
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$11,154.17 |
| Max. Negotiated Rate |
$14,540.60 |
| Rate for Payer: IEHP Medi-Cal |
$11,154.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,540.60
|
|
|
ORGANIC MENTAL HEALTH DISTURBANCES
|
Facility
IP
|
$9,523.48
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$7,305.51 |
| Max. Negotiated Rate |
$9,523.48 |
| Rate for Payer: IEHP Medi-Cal |
$7,305.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,523.48
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
IP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,448.79 |
| Max. Negotiated Rate |
$5,131.13 |
| Rate for Payer: Blue Shield of California Commercial |
$4,298.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,090.75
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cigna of CA HMO |
$4,225.63
|
| Rate for Payer: Cigna of CA PPO |
$4,225.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,414.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,414.65
|
| Rate for Payer: Galaxy Health WC |
$5,131.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,621.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,026.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,299.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,448.79
|
| Rate for Payer: Multiplan Commercial |
$4,829.30
|
| Rate for Payer: Networks By Design Commercial |
$3,018.31
|
| Rate for Payer: Prime Health Services Commercial |
$5,131.13
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION [231752]
|
Facility
OP
|
$6,036.62
|
|
|
Service Code
|
CPT J2406
|
| Hospital Charge Code |
ERX231752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$5,131.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$257.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.76
|
| Rate for Payer: BCBS Transplant Transplant |
$3,621.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4,448.99
|
| Rate for Payer: Blue Shield of California EPN |
$3,525.39
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cash Price |
$2,716.48
|
| Rate for Payer: Cigna of CA HMO |
$4,225.63
|
| Rate for Payer: Cigna of CA PPO |
$4,225.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.15
|
| Rate for Payer: Dignity Health Media |
$45.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$5,131.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3,621.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,527.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$67.10
|
| Rate for Payer: IEHP Medi-Cal |
$66.29
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$66.29
|
| Rate for Payer: IEHP Medicare Advantage |
$40.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,026.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,448.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.83
|
| Rate for Payer: Multiplan Commercial |
$4,829.30
|
| Rate for Payer: Networks By Design Commercial |
$3,018.31
|
| Rate for Payer: Prime Health Services Commercial |
$5,131.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,621.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,621.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,018.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,018.31
|
| Rate for Payer: United Healthcare HMO Rider |
$3,018.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,018.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.01
|
| Rate for Payer: Vantage Medical Group Senior |
$45.01
|
|
