|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
INJECTION(S); SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
INJECTION(S); SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
|
OP
|
$29,858.59
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,873.10 |
| Max. Negotiated Rate |
$26,872.73 |
| Rate for Payer: Adventist Health Commercial |
$5,971.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,873.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,235.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,160.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,873.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,112.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,131.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,310.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,009.20
|
| Rate for Payer: Cash Price |
$13,436.37
|
| Rate for Payer: Cash Price |
$13,436.37
|
| Rate for Payer: Central Health Plan Commercial |
$23,886.87
|
| Rate for Payer: Cigna of CA HMO |
$20,901.01
|
| Rate for Payer: Cigna of CA PPO |
$20,901.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,591.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,160.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,160.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,901.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,740.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,160.41
|
| Rate for Payer: Galaxy Health WC |
$25,379.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,915.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,872.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,711.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,873.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,873.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,960.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,351.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,022.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,971.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,849.95
|
| Rate for Payer: Multiplan Commercial |
$22,393.94
|
| Rate for Payer: Networks By Design Commercial |
$14,929.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,873.10
|
| Rate for Payer: Prime Health Services Commercial |
$25,379.80
|
| Rate for Payer: Prime Health Services Medicare |
$3,045.49
|
| Rate for Payer: Riverside University Health System MISP |
$3,160.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,915.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,915.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,205.93
|
| Rate for Payer: United Healthcare All Other HMO |
$10,907.34
|
| Rate for Payer: United Healthcare HMO Rider |
$10,671.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,778.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,873.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,591.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,160.41
|
| Rate for Payer: Vantage Medical Group Senior |
$3,160.41
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
|
IP
|
$29,858.59
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,971.72 |
| Max. Negotiated Rate |
$26,872.73 |
| Rate for Payer: Adventist Health Commercial |
$5,971.72
|
| Rate for Payer: Blue Shield of California Commercial |
$23,946.59
|
| Rate for Payer: Blue Shield of California EPN |
$15,048.73
|
| Rate for Payer: Cash Price |
$13,436.37
|
| Rate for Payer: Central Health Plan Commercial |
$23,886.87
|
| Rate for Payer: Cigna of CA HMO |
$20,901.01
|
| Rate for Payer: Cigna of CA PPO |
$20,901.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,901.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,943.44
|
| Rate for Payer: EPIC Health Plan Senior |
$11,943.44
|
| Rate for Payer: Galaxy Health WC |
$25,379.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,915.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,872.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,960.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,616.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,971.72
|
| Rate for Payer: Multiplan Commercial |
$22,393.94
|
| Rate for Payer: Networks By Design Commercial |
$14,929.30
|
| Rate for Payer: Prime Health Services Commercial |
$25,379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,205.93
|
| Rate for Payer: United Healthcare All Other HMO |
$10,907.34
|
| Rate for Payer: United Healthcare HMO Rider |
$10,671.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,778.69
|
|
|
INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 11981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$260.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Preferred Health Network WC |
$266.29
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, EXTERNAL APPROACH
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,316.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$8,144.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,847.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,316.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,771.85
|
| Rate for Payer: EPIC Health Plan Senior |
$5,847.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,718.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,442.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,123.80
|
| Rate for Payer: Multiplan WC |
$8,144.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,316.27
|
| Rate for Payer: Preferred Health Network WC |
$8,310.38
|
| Rate for Payer: Prime Health Services Medicare |
$5,635.25
|
| Rate for Payer: Prime Health Services WC |
$8,061.07
|
| Rate for Payer: Riverside University Health System MISP |
$5,847.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,316.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,974.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,847.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,316.27
|
|
|
INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$896.50 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Multiplan WC |
$13,202.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,512.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,768.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,563.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,512.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$13,202.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,768.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,563.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,512.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,345.36
|
| Rate for Payer: EPIC Health Plan Senior |
$11,563.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,240.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$896.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,512.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$990.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,717.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,086.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,512.34
|
| Rate for Payer: Preferred Health Network WC |
$13,471.96
|
| Rate for Payer: Prime Health Services Medicare |
$11,143.08
|
| Rate for Payer: Prime Health Services WC |
$13,067.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,563.57
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,512.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,768.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,563.57
|
| Rate for Payer: Vantage Medical Group Senior |
$10,512.34
|
|
|
INSERTION OF GASTROSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 49440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,583.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$377.82 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$377.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$417.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH, METHYLMETHACRYLATE) TO INTERVERTEBRAL DISC SPACE OR VERTEBRAL BODY DEFECT WITHOUT INTERBODY ARTHRODESIS, EACH CONTIGUOUS DEFECT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 22859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$488.58 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$488.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 66985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$812.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,968.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$812.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,155.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$289.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$446.98 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
INSERTION OR REPLACEMENT OF BREAST IMPLANT ON SEPARATE DAY FROM MASTECTOMY
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 19342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.18 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,512.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,768.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,563.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,512.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$19,372.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,768.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,563.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,512.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,345.36
|
| Rate for Payer: EPIC Health Plan Senior |
$11,563.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,240.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,512.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,717.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,086.54
|
| Rate for Payer: Multiplan WC |
$19,372.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,512.34
|
| Rate for Payer: Preferred Health Network WC |
$19,767.64
|
| Rate for Payer: Prime Health Services Medicare |
$11,143.08
|
| Rate for Payer: Prime Health Services WC |
$19,174.61
|
| Rate for Payer: Riverside University Health System MISP |
$11,563.57
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,512.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,768.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,563.57
|
| Rate for Payer: Vantage Medical Group Senior |
$10,512.34
|
|
|
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING; WITH CONNECTION TO 2 OR MORE ELECTRODE ARRAYS
|
Facility
|
OP
|
$97,437.00
|
|
|
Service Code
|
CPT 61886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$651.24 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,688.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,688.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,085.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$61,693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$43,656.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,688.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$65,485.46
|
| Rate for Payer: EPIC Health Plan Senior |
$43,656.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65,088.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$651.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$719.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,563.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,182.13
|
| Rate for Payer: Multiplan WC |
$61,693.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Preferred Health Network WC |
$62,952.04
|
| Rate for Payer: Prime Health Services Medicare |
$42,069.45
|
| Rate for Payer: Prime Health Services WC |
$61,063.48
|
| Rate for Payer: Riverside University Health System MISP |
$43,656.98
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$39,688.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Vantage Medical Group Senior |
$39,688.16
|
|
|
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING; WITH CONNECTION TO A SINGLE ELECTRODE ARRAY
|
Facility
|
OP
|
$71,375.00
|
|
|
Service Code
|
CPT 61885
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,688.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,688.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,085.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$43,413.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$43,656.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,688.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$65,485.46
|
| Rate for Payer: EPIC Health Plan Senior |
$43,656.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65,088.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,563.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,182.13
|
| Rate for Payer: Multiplan WC |
$43,413.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Preferred Health Network WC |
$44,299.60
|
| Rate for Payer: Prime Health Services Medicare |
$42,069.45
|
| Rate for Payer: Prime Health Services WC |
$42,970.61
|
| Rate for Payer: Riverside University Health System MISP |
$43,656.98
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$39,688.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Vantage Medical Group Senior |
$39,688.16
|
|
|
INSERTION OR REPLACEMENT OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$71,375.00
|
|
|
Service Code
|
CPT 64590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Multiplan WC |
$43,413.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$24,951.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,427.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,446.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,951.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$43,413.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,427.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,446.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,951.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,170.45
|
| Rate for Payer: EPIC Health Plan Senior |
$27,446.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40,920.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,951.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,932.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,435.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,951.79
|
| Rate for Payer: Preferred Health Network WC |
$44,299.60
|
| Rate for Payer: Prime Health Services Medicare |
$26,448.90
|
| Rate for Payer: Prime Health Services WC |
$42,970.61
|
| Rate for Payer: Riverside University Health System MISP |
$27,446.97
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,951.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,427.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,446.97
|
| Rate for Payer: Vantage Medical Group Senior |
$24,951.79
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$71,375.00
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$650.61 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,688.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,688.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$61,693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$43,656.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,688.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$65,485.46
|
| Rate for Payer: EPIC Health Plan Senior |
$43,656.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$65,088.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$650.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,563.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,182.13
|
| Rate for Payer: Multiplan WC |
$61,693.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Preferred Health Network WC |
$62,952.04
|
| Rate for Payer: Prime Health Services Medicare |
$42,069.45
|
| Rate for Payer: Prime Health Services WC |
$61,063.48
|
| Rate for Payer: Riverside University Health System MISP |
$43,656.98
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$39,688.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Vantage Medical Group Senior |
$39,688.16
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$64,470.19
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$40,718.02 |
| Max. Negotiated Rate |
$64,470.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,718.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48,522.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64,470.19
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$46,064.53
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$29,093.39 |
| Max. Negotiated Rate |
$46,064.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,093.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,669.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,064.53
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$24,625.48
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$15,552.94 |
| Max. Negotiated Rate |
$24,625.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,552.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,533.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,625.48
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$35,077.12
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$22,153.97 |
| Max. Negotiated Rate |
$35,077.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,153.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,400.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,077.12
|
|
