|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$9,790.48
|
|
|
Service Code
|
APR-DRG 2812
|
| Min. Negotiated Rate |
$8,215.79 |
| Max. Negotiated Rate |
$9,790.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,215.79
|
| Rate for Payer: IEHP medi-cal |
$9,790.48
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$18,732.06
|
|
|
Service Code
|
APR-DRG 2814
|
| Min. Negotiated Rate |
$15,719.21 |
| Max. Negotiated Rate |
$18,732.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,719.21
|
| Rate for Payer: IEHP medi-cal |
$18,732.06
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$7,382.58
|
|
|
Service Code
|
APR-DRG 2811
|
| Min. Negotiated Rate |
$6,195.17 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,195.17
|
| Rate for Payer: IEHP medi-cal |
$7,382.58
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$11,636.45
|
|
|
Service Code
|
APR-DRG 3823
|
| Min. Negotiated Rate |
$9,764.86 |
| Max. Negotiated Rate |
$11,636.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,764.86
|
| Rate for Payer: IEHP medi-cal |
$11,636.45
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$17,233.12
|
|
|
Service Code
|
APR-DRG 3824
|
| Min. Negotiated Rate |
$14,461.36 |
| Max. Negotiated Rate |
$17,233.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,461.36
|
| Rate for Payer: IEHP medi-cal |
$17,233.12
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$6,976.80
|
|
|
Service Code
|
APR-DRG 3821
|
| Min. Negotiated Rate |
$5,854.66 |
| Max. Negotiated Rate |
$6,976.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,854.66
|
| Rate for Payer: IEHP medi-cal |
$6,976.80
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$8,215.46
|
|
|
Service Code
|
APR-DRG 3822
|
| Min. Negotiated Rate |
$6,894.10 |
| Max. Negotiated Rate |
$8,215.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,894.10
|
| Rate for Payer: IEHP medi-cal |
$8,215.46
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$10,666.08
|
|
|
Service Code
|
APR-DRG 4213
|
| Min. Negotiated Rate |
$8,950.56 |
| Max. Negotiated Rate |
$10,666.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,950.56
|
| Rate for Payer: IEHP medi-cal |
$10,666.08
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$7,038.20
|
|
|
Service Code
|
APR-DRG 4212
|
| Min. Negotiated Rate |
$5,906.18 |
| Max. Negotiated Rate |
$7,038.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,906.18
|
| Rate for Payer: IEHP medi-cal |
$7,038.20
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$4,706.37
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$3,949.40 |
| Max. Negotiated Rate |
$4,706.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,949.40
|
| Rate for Payer: IEHP medi-cal |
$4,706.37
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$20,572.68
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$17,263.79 |
| Max. Negotiated Rate |
$20,572.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,263.79
|
| Rate for Payer: IEHP medi-cal |
$20,572.68
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
OP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
NDG213757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: BCBS Transplant Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.14
|
| Rate for Payer: IEHP medi-cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: Riverside University Health MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
IP
|
$2.86
|
|
|
Service Code
|
NDC 78573-00081
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
OP
|
$2.86
|
|
|
Service Code
|
NDC 78573-00081
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: BCBS Transplant Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.14
|
| Rate for Payer: IEHP medi-cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: Riverside University Health MISP |
$1.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
IP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
NDG213757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
Manipulation, finger joint, under anesthesia, each joint
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 26340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| 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 |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,008.09 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| 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 |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,008.09 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| 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 |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Manipulation, wrist, under anesthesia
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 25259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,008.09 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$2,008.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| 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 |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-12
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-02
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-02
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-12
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,147.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| 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 |
$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 |
$11,139.02
|
| 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 |
$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
|
|
|
Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,762.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| 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 |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: IEHP medi-cal |
$7,858.14
|
| Rate for Payer: IEHP Medicare Advantage |
$4,762.51
|
| Rate for Payer: Innovage PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health MISP |
$5,238.76
|
| 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 |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
