|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 11981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: IEHP medi-cal |
$263.34
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Innovage PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health MISP |
$175.56
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 66183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,080.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,080.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| 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 |
$5,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,858.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,080.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,080.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,331.20
|
| Rate for Payer: IEHP medi-cal |
$8,382.00
|
| Rate for Payer: IEHP Medicare Advantage |
$5,080.00
|
| Rate for Payer: Innovage PACE Commercial |
$7,620.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,080.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,807.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,807.20
|
| Rate for Payer: Prime Health Services Medicare |
$5,384.80
|
| Rate for Payer: Riverside University Health MISP |
$5,588.00
|
| 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 |
$7,620.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,080.00
|
|
|
Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 0449T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,530.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| 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 |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6,530.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,815.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,530.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,709.54
|
| Rate for Payer: IEHP medi-cal |
$10,774.85
|
| Rate for Payer: IEHP Medicare Advantage |
$6,530.21
|
| Rate for Payer: Innovage PACE Commercial |
$9,795.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,530.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.48
|
| Rate for Payer: Prime Health Services Medicare |
$6,922.02
|
| Rate for Payer: Riverside University Health MISP |
$7,183.23
|
| 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 |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
Insertion of breast implant on same day of mastectomy (ie, immediate)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,147.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| 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 |
$11,139.02
|
| 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 |
$8,147.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,999.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,147.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,362.18
|
| Rate for Payer: IEHP medi-cal |
$13,443.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Innovage PACE Commercial |
$12,221.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,147.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,917.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,917.88
|
| Rate for Payer: Multiplan WC |
$11,139.02
|
| Rate for Payer: Preferred Health Network WC |
$11,366.35
|
| Rate for Payer: Prime Health Services Medicare |
$8,636.53
|
| Rate for Payer: Prime Health Services WC |
$11,025.36
|
| Rate for Payer: Riverside University Health MISP |
$8,962.44
|
| 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 |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
|
Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
|
Facility
OP
|
$7,027.00
|
|
|
Service Code
|
CPT 49440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,377.45 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| 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 |
$2,377.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: IEHP medi-cal |
$3,922.79
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Innovage PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health MISP |
$2,615.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff
|
Facility
OP
|
$51,156.00
|
|
|
Service Code
|
CPT 53445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,203.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,456.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$25,203.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,024.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$25,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41,333.41
|
| Rate for Payer: IEHP medi-cal |
$41,585.44
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Innovage PACE Commercial |
$37,804.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,203.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,772.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,772.42
|
| Rate for Payer: Multiplan WC |
$34,456.53
|
| Rate for Payer: Preferred Health Network WC |
$35,159.72
|
| Rate for Payer: Prime Health Services Medicare |
$26,715.50
|
| Rate for Payer: Prime Health Services WC |
$34,104.93
|
| Rate for Payer: Riverside University Health MISP |
$27,723.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
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
|
$7,609.02
|
|
|
Service Code
|
CPT 22853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| 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
|
|
|
Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 66985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,911.63 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| 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: 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 |
$2,911.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$4,804.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Insertion of intrauterine device (IUD)
|
Facility
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| 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
|
|
|
Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,620.00
|
|
|
Service Code
|
CPT 57267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| 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
|
|
|
Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
|
Facility
OP
|
$51,156.00
|
|
|
Service Code
|
CPT 54405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,203.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,456.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$25,203.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,024.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$25,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41,333.41
|
| Rate for Payer: IEHP medi-cal |
$41,585.44
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Innovage PACE Commercial |
$37,804.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,203.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,772.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,772.42
|
| Rate for Payer: Multiplan WC |
$34,456.53
|
| Rate for Payer: Preferred Health Network WC |
$35,159.72
|
| Rate for Payer: Prime Health Services Medicare |
$26,715.50
|
| Rate for Payer: Prime Health Services WC |
$34,104.93
|
| Rate for Payer: Riverside University Health MISP |
$27,723.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis
|
Facility
OP
|
$67,976.00
|
|
|
Service Code
|
CPT 0308T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,676.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,515.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23,844.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,676.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,635.51
|
| 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 |
$21,676.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,515.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,676.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,676.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,550.21
|
| Rate for Payer: IEHP medi-cal |
$35,766.98
|
| Rate for Payer: IEHP Medicare Advantage |
$21,676.96
|
| Rate for Payer: Innovage PACE Commercial |
$32,515.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,676.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,047.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,047.13
|
| Rate for Payer: Multiplan WC |
$29,635.51
|
| Rate for Payer: Preferred Health Network WC |
$30,240.32
|
| Rate for Payer: Prime Health Services Medicare |
$22,977.58
|
| Rate for Payer: Prime Health Services WC |
$29,333.11
|
| Rate for Payer: Riverside University Health MISP |
$23,844.66
|
| 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 |
$32,515.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,844.66
|
| Rate for Payer: Vantage Medical Group Senior |
$21,676.96
|
|
|
Insertion of penile prosthesis; inflatable (self-contained)
|
Facility
OP
|
$51,156.00
|
|
|
Service Code
|
CPT 54401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,203.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$34,456.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$25,203.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,024.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$25,203.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41,333.41
|
| Rate for Payer: IEHP medi-cal |
$41,585.44
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Innovage PACE Commercial |
$37,804.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,203.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,772.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,772.42
|
| Rate for Payer: Multiplan WC |
$34,456.53
|
| Rate for Payer: Preferred Health Network WC |
$35,159.72
|
| Rate for Payer: Prime Health Services Medicare |
$26,715.50
|
| Rate for Payer: Prime Health Services WC |
$34,104.93
|
| Rate for Payer: Riverside University Health MISP |
$27,723.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,982.55 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: IEHP medi-cal |
$6,571.21
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Innovage PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health MISP |
$4,380.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
Insertion of tunneled intraperitoneal catheter for dialysis, open
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,322.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 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 |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| 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/Senior |
$7,089.10
|
| Rate for Payer: IEHP medi-cal |
$7,132.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Innovage PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health MISP |
$4,754.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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
|
|
|
Insertion or replacement of breast implant on separate day from mastectomy
|
Facility
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 19342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,777.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,666.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,955.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,777.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,102.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$11,777.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,666.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,900.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,777.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,777.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19,315.85
|
| Rate for Payer: IEHP medi-cal |
$19,433.63
|
| Rate for Payer: IEHP Medicare Advantage |
$11,777.96
|
| Rate for Payer: Innovage PACE Commercial |
$17,666.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,777.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,782.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,782.47
|
| Rate for Payer: Multiplan WC |
$16,102.15
|
| Rate for Payer: Preferred Health Network WC |
$16,430.77
|
| Rate for Payer: Prime Health Services Medicare |
$12,484.64
|
| Rate for Payer: Prime Health Services WC |
$15,937.85
|
| Rate for Payer: Riverside University Health MISP |
$12,955.76
|
| 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 |
$17,666.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,955.76
|
| Rate for Payer: Vantage Medical Group Senior |
$11,777.96
|
|
|
Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays
|
Facility
OP
|
$103,995.00
|
|
|
Service Code
|
CPT 61886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,797.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38,797.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,273.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$53,041.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$38,797.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,376.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$38,797.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63,628.21
|
| Rate for Payer: IEHP medi-cal |
$64,016.19
|
| Rate for Payer: IEHP Medicare Advantage |
$38,797.69
|
| Rate for Payer: Innovage PACE Commercial |
$58,196.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,797.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,988.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,988.90
|
| Rate for Payer: Multiplan WC |
$53,041.98
|
| Rate for Payer: Preferred Health Network WC |
$54,124.47
|
| Rate for Payer: Prime Health Services Medicare |
$41,125.55
|
| Rate for Payer: Prime Health Services WC |
$52,500.74
|
| Rate for Payer: Riverside University Health MISP |
$42,677.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Vantage Medical Group Senior |
$38,797.69
|
|
|
Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
|
Facility
OP
|
$67,976.00
|
|
|
Service Code
|
CPT 61885
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,332.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40,998.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27,332.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,273.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$37,366.81
|
| 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 |
$27,332.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,998.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,898.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,332.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$27,332.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44,824.56
|
| Rate for Payer: IEHP medi-cal |
$45,097.88
|
| Rate for Payer: IEHP Medicare Advantage |
$27,332.05
|
| Rate for Payer: Innovage PACE Commercial |
$40,998.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,332.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,624.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,624.95
|
| Rate for Payer: Multiplan WC |
$37,366.81
|
| Rate for Payer: Preferred Health Network WC |
$38,129.40
|
| Rate for Payer: Prime Health Services Medicare |
$28,971.97
|
| Rate for Payer: Prime Health Services WC |
$36,985.52
|
| Rate for Payer: Riverside University Health MISP |
$30,065.26
|
| 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 |
$40,998.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: Vantage Medical Group Senior |
$27,332.05
|
|
|
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
|
$67,976.00
|
|
|
Service Code
|
CPT 64590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,332.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40,998.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27,332.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$37,366.81
|
| 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 |
$27,332.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,998.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,898.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,332.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$27,332.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44,824.56
|
| Rate for Payer: IEHP medi-cal |
$45,097.88
|
| Rate for Payer: IEHP Medicare Advantage |
$27,332.05
|
| Rate for Payer: Innovage PACE Commercial |
$40,998.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,332.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,624.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,624.95
|
| Rate for Payer: Multiplan WC |
$37,366.81
|
| Rate for Payer: Preferred Health Network WC |
$38,129.40
|
| Rate for Payer: Prime Health Services Medicare |
$28,971.97
|
| Rate for Payer: Prime Health Services WC |
$36,985.52
|
| Rate for Payer: Riverside University Health MISP |
$30,065.26
|
| 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 |
$40,998.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: Vantage Medical Group Senior |
$27,332.05
|
|
|
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
|
$67,976.00
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,797.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38,797.69
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$53,041.98
|
| 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 |
$38,797.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,376.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$38,797.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63,628.21
|
| Rate for Payer: IEHP medi-cal |
$64,016.19
|
| Rate for Payer: IEHP Medicare Advantage |
$38,797.69
|
| Rate for Payer: Innovage PACE Commercial |
$58,196.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,797.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,988.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,988.90
|
| Rate for Payer: Multiplan WC |
$53,041.98
|
| Rate for Payer: Preferred Health Network WC |
$54,124.47
|
| Rate for Payer: Prime Health Services Medicare |
$41,125.55
|
| Rate for Payer: Prime Health Services WC |
$52,500.74
|
| Rate for Payer: Riverside University Health MISP |
$42,677.46
|
| 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 |
$58,196.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Vantage Medical Group Senior |
$38,797.69
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$36,225.45
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$30,398.98 |
| Max. Negotiated Rate |
$36,225.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,398.98
|
| Rate for Payer: IEHP medi-cal |
$36,225.45
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$60,000.23
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$50,349.84 |
| Max. Negotiated Rate |
$60,000.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$50,349.84
|
| Rate for Payer: IEHP medi-cal |
$60,000.23
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$19,710.43
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$16,540.22 |
| Max. Negotiated Rate |
$19,710.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,540.22
|
| Rate for Payer: IEHP medi-cal |
$19,710.43
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$23,383.69
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$19,622.68 |
| Max. Negotiated Rate |
$23,383.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,622.68
|
| Rate for Payer: IEHP medi-cal |
$23,383.69
|
|
