|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$3,508.00
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$3,508.00 |
| Max. Negotiated Rate |
$3,508.00 |
| Rate for Payer: IEHP Medi-Cal |
$3,508.00
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$15,334.34
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$15,334.34 |
| Max. Negotiated Rate |
$15,334.34 |
| Rate for Payer: IEHP Medi-Cal |
$15,334.34
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
IP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
NDG213757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.96
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
OP
|
$2.86
|
|
|
Service Code
|
NDC 78573-00081
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.96
|
| 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 |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: Dignity Health Senior |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
OP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
NDG213757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.96
|
| 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 |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: Dignity Health Senior |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
| 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 |
$0.52 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.96
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.14
|
|
|
Manipulation, finger joint, under anesthesia, each joint
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26340
|
| Min. Negotiated Rate |
$357.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$357.77
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 27570
|
| Min. Negotiated Rate |
$121.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$121.38
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 23700
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 25259
|
| Min. Negotiated Rate |
$465.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$465.21
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| 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 0990-7715-02
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
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 |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
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 |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| 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 |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| 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
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 |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| 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 |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| 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
|
$15,480.57
|
|
|
Service Code
|
CPT 19307
|
| Min. Negotiated Rate |
$1,434.12 |
| Max. Negotiated Rate |
$15,480.57 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| 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 HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,962.44
|
| Rate for Payer: Dignity Health Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,147.67
|
| Rate for Payer: Humana Medicare |
$8,147.67
|
| Rate for Payer: IEHP Medi-Cal |
$1,434.12
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,614.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,266.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,266.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,962.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8,147.67
|
| 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
|
$9,616.00
|
|
|
Service Code
|
CPT 19301
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: IEHP Medi-Cal |
$104.07
|
| Rate for Payer: IEHP Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,048.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,238.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4,762.51
|
| 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
|
|
|
Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy
|
Facility
OP
|
$15,480.57
|
|
|
Service Code
|
CPT 19302
|
| Min. Negotiated Rate |
$1,080.32 |
| Max. Negotiated Rate |
$15,480.57 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| 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 HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,962.44
|
| Rate for Payer: Dignity Health Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,147.67
|
| Rate for Payer: Humana Medicare |
$8,147.67
|
| Rate for Payer: IEHP Medi-Cal |
$1,080.32
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,614.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,266.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,266.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,962.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8,147.67
|
| 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 PROCEDURES
|
Facility
IP
|
$11,220.43
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$11,220.43 |
| Max. Negotiated Rate |
$11,220.43 |
| Rate for Payer: IEHP Medi-Cal |
$11,220.43
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$33,998.58
|
|
|
Service Code
|
APR-DRG 3624
|
| Min. Negotiated Rate |
$33,998.58 |
| Max. Negotiated Rate |
$33,998.58 |
| Rate for Payer: IEHP Medi-Cal |
$33,998.58
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$19,146.77
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$19,146.77 |
| Max. Negotiated Rate |
$19,146.77 |
| Rate for Payer: IEHP Medi-Cal |
$19,146.77
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$16,155.13
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$16,155.13 |
| Max. Negotiated Rate |
$16,155.13 |
| Rate for Payer: IEHP Medi-Cal |
$16,155.13
|
|
|
Mastectomy, simple, complete
|
Facility
OP
|
$15,480.57
|
|
|
Service Code
|
CPT 19303
|
| Min. Negotiated Rate |
$238.02 |
| Max. Negotiated Rate |
$15,480.57 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| 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 HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,962.44
|
| Rate for Payer: Dignity Health Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,147.67
|
| Rate for Payer: Humana Medicare |
$8,147.67
|
| Rate for Payer: IEHP Medi-Cal |
$238.02
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,614.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,266.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,266.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,962.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8,147.67
|
| 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
|
|
|
Mastoidectomy; complete
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 69502
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Mastopexy
|
Facility
OP
|
$15,480.57
|
|
|
Service Code
|
CPT 19316
|
| Min. Negotiated Rate |
$143.46 |
| Max. Negotiated Rate |
$15,480.57 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| 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 HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,962.44
|
| Rate for Payer: Dignity Health Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,147.67
|
| Rate for Payer: Humana Medicare |
$8,147.67
|
| Rate for Payer: IEHP Medi-Cal |
$143.46
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,614.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,266.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,266.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,962.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8,147.67
|
| 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
|
|
|
Maternity Normal
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0UQ98ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
