|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$299.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$48.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$95.70
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Caremore Medicare Advantage |
$48.29
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.40
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.20
|
| Rate for Payer: IEHP medi-cal |
$79.68
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Innovage PACE Commercial |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Medicare |
$51.19
|
| Rate for Payer: Riverside University Health MISP |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
IP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.95
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.40
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$299.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$48.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$95.70
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Caremore Medicare Advantage |
$48.29
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.40
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.20
|
| Rate for Payer: IEHP medi-cal |
$79.68
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Innovage PACE Commercial |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Medicare |
$51.19
|
| Rate for Payer: Riverside University Health MISP |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
IP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.95
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.40
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
OP
|
$11.21
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG210297B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$278.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$278.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.75
|
| Rate for Payer: BCBS Transplant Transplant |
$6.73
|
| Rate for Payer: Blue Shield of California Commercial |
$112.37
|
| Rate for Payer: Blue Shield of California EPN |
$102.15
|
| Rate for Payer: Caremore Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Central Health Plan Commercial |
$8.97
|
| Rate for Payer: Cigna of CA HMO |
$7.85
|
| Rate for Payer: Cigna of CA PPO |
$7.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.98
|
| Rate for Payer: Galaxy Health WC |
$9.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$73.76
|
| Rate for Payer: IEHP medi-cal |
$74.21
|
| Rate for Payer: IEHP Medicare Advantage |
$44.98
|
| Rate for Payer: Innovage PACE Commercial |
$67.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.53
|
| Rate for Payer: Prime Health Services Medicare |
$47.68
|
| Rate for Payer: Riverside University Health MISP |
$49.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: Vantage Medical Group Senior |
$44.98
|
|
|
IMMUNE GLOB,GAMM(IGG) 5 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [210297]
|
Facility
IP
|
$11.21
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG210297B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Blue Shield of California Commercial |
$8.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Central Health Plan Commercial |
$8.97
|
| Rate for Payer: Cigna of CA HMO |
$7.85
|
| Rate for Payer: Cigna of CA PPO |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.48
|
| Rate for Payer: Galaxy Health WC |
$9.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.53
|
|
|
IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107752]
|
Facility
OP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG107752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$308.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$49.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$9.86
|
| Rate for Payer: Blue Shield of California Commercial |
$80.64
|
| Rate for Payer: Blue Shield of California EPN |
$73.31
|
| Rate for Payer: Caremore Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Central Health Plan Commercial |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.79
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.65
|
| Rate for Payer: IEHP medi-cal |
$82.15
|
| Rate for Payer: IEHP Medicare Advantage |
$49.79
|
| Rate for Payer: Innovage PACE Commercial |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.71
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Prime Health Services Medicare |
$52.77
|
| Rate for Payer: Riverside University Health MISP |
$54.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: Vantage Medical Group Senior |
$49.79
|
|
|
IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107752]
|
Facility
IP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG107752
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Blue Shield of California Commercial |
$12.32
|
| Rate for Payer: Blue Shield of California EPN |
$8.77
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Central Health Plan Commercial |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.57
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$164,861.80
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$138,345.56 |
| Max. Negotiated Rate |
$164,861.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$138,345.56
|
| Rate for Payer: IEHP medi-cal |
$164,861.80
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$173,537.75
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$145,626.08 |
| Max. Negotiated Rate |
$173,537.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$145,626.08
|
| Rate for Payer: IEHP medi-cal |
$173,537.75
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$216,136.68
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$181,373.44 |
| Max. Negotiated Rate |
$216,136.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$181,373.44
|
| Rate for Payer: IEHP medi-cal |
$216,136.68
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
IP
|
$282,123.30
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$236,746.82 |
| Max. Negotiated Rate |
$282,123.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$236,746.82
|
| Rate for Payer: IEHP medi-cal |
$282,123.30
|
|
|
Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 15777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump
|
Facility
OP
|
$67,976.00
|
|
|
Service Code
|
CPT 62361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,282.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,424.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,511.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,282.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$30,463.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$22,282.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,424.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,081.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,282.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,282.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,543.78
|
| Rate for Payer: IEHP medi-cal |
$36,766.60
|
| Rate for Payer: IEHP Medicare Advantage |
$22,282.79
|
| Rate for Payer: Innovage PACE Commercial |
$33,424.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,282.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,858.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,858.94
|
| Rate for Payer: Multiplan WC |
$30,463.76
|
| Rate for Payer: Preferred Health Network WC |
$31,085.47
|
| Rate for Payer: Prime Health Services Medicare |
$23,619.76
|
| Rate for Payer: Prime Health Services WC |
$30,152.91
|
| Rate for Payer: Riverside University Health MISP |
$24,511.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,424.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,511.07
|
| Rate for Payer: Vantage Medical Group Senior |
$22,282.79
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming
|
Facility
OP
|
$67,976.00
|
|
|
Service Code
|
CPT 62362
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,282.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,424.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,511.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,282.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$30,463.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$22,282.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,424.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,081.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,282.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,282.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,543.78
|
| Rate for Payer: IEHP medi-cal |
$36,766.60
|
| Rate for Payer: IEHP Medicare Advantage |
$22,282.79
|
| Rate for Payer: Innovage PACE Commercial |
$33,424.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,282.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,858.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,858.94
|
| Rate for Payer: Multiplan WC |
$30,463.76
|
| Rate for Payer: Preferred Health Network WC |
$31,085.47
|
| Rate for Payer: Prime Health Services Medicare |
$23,619.76
|
| Rate for Payer: Prime Health Services WC |
$30,152.91
|
| Rate for Payer: Riverside University Health MISP |
$24,511.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,424.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,511.07
|
| Rate for Payer: Vantage Medical Group Senior |
$22,282.79
|
|
|
Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir
|
Facility
OP
|
$36,766.60
|
|
|
Service Code
|
CPT 62360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$36,766.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,282.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,424.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,511.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,282.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$30,463.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$22,282.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,424.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,081.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,282.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$22,282.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,543.78
|
| Rate for Payer: IEHP medi-cal |
$36,766.60
|
| Rate for Payer: IEHP Medicare Advantage |
$22,282.79
|
| Rate for Payer: Innovage PACE Commercial |
$33,424.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,282.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,858.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,858.94
|
| Rate for Payer: Multiplan WC |
$30,463.76
|
| Rate for Payer: Preferred Health Network WC |
$31,085.47
|
| Rate for Payer: Prime Health Services Medicare |
$23,619.76
|
| Rate for Payer: Prime Health Services WC |
$30,152.91
|
| Rate for Payer: Riverside University Health MISP |
$24,511.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,424.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,511.07
|
| Rate for Payer: Vantage Medical Group Senior |
$22,282.79
|
|
|
Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex
|
Facility
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 69716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,443.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| 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 Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,481.26
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$16,443.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| 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/Senior |
$26,968.11
|
| Rate for Payer: IEHP medi-cal |
$27,132.55
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Innovage PACE Commercial |
$24,665.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,034.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Multiplan WC |
$22,481.26
|
| Rate for Payer: Preferred Health Network WC |
$22,940.06
|
| Rate for Payer: Prime Health Services Medicare |
$17,430.61
|
| Rate for Payer: Prime Health Services WC |
$22,251.86
|
| Rate for Payer: Riverside University Health MISP |
$18,088.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| 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
|
|
|
Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor
|
Facility
OP
|
$48,045.00
|
|
|
Service Code
|
CPT 69714
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,887.36 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,443.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| 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 Exchange |
$22,162.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,034.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,481.26
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$16,443.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| 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/Senior |
$26,968.11
|
| Rate for Payer: IEHP medi-cal |
$27,132.55
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Innovage PACE Commercial |
$24,665.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,034.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Multiplan WC |
$22,481.26
|
| Rate for Payer: Preferred Health Network WC |
$22,940.06
|
| Rate for Payer: Prime Health Services Medicare |
$17,430.61
|
| Rate for Payer: Prime Health Services WC |
$22,251.86
|
| Rate for Payer: Riverside University Health MISP |
$18,088.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| 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
|
|
|
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 62350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,323.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,378.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$8,323.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,649.79
|
| Rate for Payer: IEHP medi-cal |
$13,733.02
|
| Rate for Payer: IEHP Medicare Advantage |
$8,323.04
|
| Rate for Payer: Innovage PACE Commercial |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,152.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Preferred Health Network WC |
$11,610.99
|
| Rate for Payer: Prime Health Services Medicare |
$8,822.42
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Riverside University Health MISP |
$9,155.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
Impression and custom preparation; oral surgical splint
|
Facility
OP
|
$5,779.00
|
|
|
Service Code
|
CPT 21085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$305.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,157.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: IEHP medi-cal |
$503.56
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Innovage PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health MISP |
$335.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
IP
|
$26,930.16
|
|
|
Service Code
|
APR-DRG 4234
|
| Min. Negotiated Rate |
$22,598.74 |
| Max. Negotiated Rate |
$26,930.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,598.74
|
| Rate for Payer: IEHP medi-cal |
$26,930.16
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
IP
|
$6,049.14
|
|
|
Service Code
|
APR-DRG 4231
|
| Min. Negotiated Rate |
$5,076.20 |
| Max. Negotiated Rate |
$6,049.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,076.20
|
| Rate for Payer: IEHP medi-cal |
$6,049.14
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
IP
|
$7,924.49
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$6,649.92 |
| Max. Negotiated Rate |
$7,924.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,649.92
|
| Rate for Payer: IEHP medi-cal |
$7,924.49
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
IP
|
$12,447.99
|
|
|
Service Code
|
APR-DRG 4233
|
| Min. Negotiated Rate |
$10,445.87 |
| Max. Negotiated Rate |
$12,447.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,445.87
|
| Rate for Payer: IEHP medi-cal |
$12,447.99
|
|
|
Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 11106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.71 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
