|
Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 49440
|
| Min. Negotiated Rate |
$1,436.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,436.29
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,377.45
|
| 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
|
$47,886.27
|
|
|
Service Code
|
CPT 53445
|
| Min. Negotiated Rate |
$198.04 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: IEHP Medi-Cal |
$198.04
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 22853
|
| Min. Negotiated Rate |
$342.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$342.67
|
|
|
Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
|
Facility
OP
|
$8,576.00
|
|
|
Service Code
|
CPT 66985
|
| Min. Negotiated Rate |
$737.02 |
| Max. Negotiated Rate |
$8,576.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 HMO/PPO |
$8,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$737.02
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 58300
|
| Min. Negotiated Rate |
$262.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$262.42
|
|
|
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
|
$9,616.00
|
|
|
Service Code
|
CPT 57267
|
| Min. Negotiated Rate |
$341.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$341.13
|
|
|
Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
|
Facility
OP
|
$47,886.27
|
|
|
Service Code
|
CPT 54405
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| 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
|
$41,186.22
|
|
|
Service Code
|
CPT 0308T
|
| Min. Negotiated Rate |
$2,869.00 |
| Max. Negotiated Rate |
$41,186.22 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,515.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,844.66
|
| Rate for Payer: Dignity Health Senior |
$21,676.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,676.96
|
| Rate for Payer: Humana Medicare |
$21,676.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,676.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,186.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,578.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,312.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,312.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$23,844.66
|
| Rate for Payer: TriValley Medical Group Senior |
$21,676.96
|
| 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
|
$47,886.27
|
|
|
Service Code
|
CPT 54401
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 36561
|
| Min. Negotiated Rate |
$405.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$405.60
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 36558
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$211.58
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 49421
|
| Min. Negotiated Rate |
$408.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: IEHP Medi-Cal |
$408.30
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,322.62
|
| 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
|
$22,378.12
|
|
|
Service Code
|
CPT 19342
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$22,378.12 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,666.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,955.76
|
| Rate for Payer: Dignity Health Senior |
$11,777.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11,777.96
|
| Rate for Payer: Humana Medicare |
$11,777.96
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$11,777.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22,378.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,897.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,840.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,840.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$12,955.76
|
| Rate for Payer: TriValley Medical Group Senior |
$11,777.96
|
| 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
|
$73,715.61
|
|
|
Service Code
|
CPT 61886
|
| Min. Negotiated Rate |
$590.66 |
| Max. Negotiated Rate |
$73,715.61 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,677.46
|
| Rate for Payer: Dignity Health Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$38,797.69
|
| Rate for Payer: Humana Medicare |
$38,797.69
|
| Rate for Payer: IEHP Medi-Cal |
$590.66
|
| Rate for Payer: IEHP Medicare Advantage |
$38,797.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73,715.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,781.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,885.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,885.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$42,677.46
|
| Rate for Payer: TriValley Medical Group Senior |
$38,797.69
|
| 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
|
$51,930.90
|
|
|
Service Code
|
CPT 61885
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$51,930.90 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,065.26
|
| Rate for Payer: Dignity Health Senior |
$27,332.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$27,332.05
|
| Rate for Payer: Humana Medicare |
$27,332.05
|
| Rate for Payer: IEHP Medi-Cal |
$120.81
|
| Rate for Payer: IEHP Medicare Advantage |
$27,332.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51,930.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,251.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,438.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,438.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$30,065.26
|
| Rate for Payer: TriValley Medical Group Senior |
$27,332.05
|
| 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
|
$51,930.90
|
|
|
Service Code
|
CPT 64590
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$51,930.90 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$12,266.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,065.26
|
| Rate for Payer: Dignity Health Senior |
$27,332.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$27,332.05
|
| Rate for Payer: Humana Medicare |
$27,332.05
|
| Rate for Payer: IEHP Medi-Cal |
$210.82
|
| Rate for Payer: IEHP Medicare Advantage |
$27,332.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51,930.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,251.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,438.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,438.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$30,065.26
|
| Rate for Payer: TriValley Medical Group Senior |
$27,332.05
|
| 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
|
$73,715.61
|
|
|
Service Code
|
CPT 63685
|
| Min. Negotiated Rate |
$117.90 |
| Max. Negotiated Rate |
$73,715.61 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,677.46
|
| Rate for Payer: Dignity Health Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$38,797.69
|
| Rate for Payer: Humana Medicare |
$38,797.69
|
| Rate for Payer: IEHP Medi-Cal |
$117.90
|
| Rate for Payer: IEHP Medicare Advantage |
$38,797.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73,715.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,781.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,885.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,885.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$42,677.46
|
| Rate for Payer: TriValley Medical Group Senior |
$38,797.69
|
| 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
|
$27,001.48
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$27,001.48 |
| Max. Negotiated Rate |
$27,001.48 |
| Rate for Payer: IEHP Medi-Cal |
$27,001.48
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$44,722.56
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$44,722.56 |
| Max. Negotiated Rate |
$44,722.56 |
| Rate for Payer: IEHP Medi-Cal |
$44,722.56
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$17,429.58
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$17,429.58 |
| Max. Negotiated Rate |
$17,429.58 |
| Rate for Payer: IEHP Medi-Cal |
$17,429.58
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$14,691.63
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$14,691.63 |
| Max. Negotiated Rate |
$14,691.63 |
| Rate for Payer: IEHP Medi-Cal |
$14,691.63
|
|
|
Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 50391
|
| Min. Negotiated Rate |
$185.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$185.94
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$308.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
OP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$25.26
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: Dignity Health Senior |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.17
|
| Rate for Payer: Heritage Provider Network Senior |
$25.17
|
| Rate for Payer: IEHP Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
IP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.94
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.53
|
| Rate for Payer: Heritage Provider Network Senior |
$27.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
OP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Adventist Health Commercial |
$7.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$21.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.57
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.79
|
| Rate for Payer: Dignity Health Senior |
$29.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.70
|
| Rate for Payer: Heritage Provider Network Senior |
$21.70
|
| Rate for Payer: IEHP Medi-Cal |
$8.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$26.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Vantage Medical Group Senior |
$29.79
|
|
