|
NEPAFENAC 0.1 % EYE DROPS,SUSPENSION [42486]
|
Facility
IP
|
$125.38
|
|
|
Service Code
|
NDC 0065-0002-03
|
| Hospital Charge Code |
1740380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$94.04 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.14
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.88
|
| Rate for Payer: Heritage Provider Network Senior |
$84.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.34
|
| Rate for Payer: Multiplan Commercial |
$94.04
|
|
|
NEPAFENAC 0.1 % EYE DROPS,SUSPENSION [42486]
|
Facility
OP
|
$125.38
|
|
|
Service Code
|
NDC 0065-0002-03
|
| Hospital Charge Code |
1740380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$106.57 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$94.04
|
| Rate for Payer: Blue Shield of California Commercial |
$77.86
|
| Rate for Payer: Blue Shield of California EPN |
$73.60
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.57
|
| Rate for Payer: Dignity Health Senior |
$106.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.61
|
| Rate for Payer: Heritage Provider Network Senior |
$77.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.34
|
| Rate for Payer: Multiplan Commercial |
$94.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.57
|
| Rate for Payer: Vantage Medical Group Senior |
$106.57
|
|
|
NEPAFENAC 0.3 % EYE DROPS,SUSPENSION [199693]
|
Facility
OP
|
$144.84
|
|
|
Service Code
|
NDC 0078-0743-03
|
| Hospital Charge Code |
NDG199693B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$123.11 |
| Rate for Payer: Adventist Health Commercial |
$28.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$123.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$79.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$108.63
|
| Rate for Payer: Blue Shield of California Commercial |
$89.95
|
| Rate for Payer: Blue Shield of California EPN |
$85.02
|
| Rate for Payer: Cash Price |
$65.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.11
|
| Rate for Payer: Dignity Health Senior |
$123.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.66
|
| Rate for Payer: Heritage Provider Network Senior |
$89.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.21
|
| Rate for Payer: Multiplan Commercial |
$108.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.11
|
| Rate for Payer: Vantage Medical Group Senior |
$123.11
|
|
|
NEPAFENAC 0.3 % EYE DROPS,SUSPENSION [199693]
|
Facility
IP
|
$144.84
|
|
|
Service Code
|
NDC 0078-0743-03
|
| Hospital Charge Code |
NDG199693B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Adventist Health Commercial |
$28.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.51
|
| Rate for Payer: Cash Price |
$65.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.06
|
| Rate for Payer: Heritage Provider Network Senior |
$98.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.21
|
| Rate for Payer: Multiplan Commercial |
$108.63
|
|
|
NEPHRITIS AND NEPHROSIS
|
Facility
IP
|
$5,430.14
|
|
|
Service Code
|
APR-DRG 4622
|
| Min. Negotiated Rate |
$5,430.14 |
| Max. Negotiated Rate |
$5,430.14 |
| Rate for Payer: IEHP Medi-Cal |
$5,430.14
|
|
|
NEPHRITIS AND NEPHROSIS
|
Facility
IP
|
$10,078.30
|
|
|
Service Code
|
APR-DRG 4623
|
| Min. Negotiated Rate |
$10,078.30 |
| Max. Negotiated Rate |
$10,078.30 |
| Rate for Payer: IEHP Medi-Cal |
$10,078.30
|
|
|
NEPHRITIS AND NEPHROSIS
|
Facility
IP
|
$3,718.93
|
|
|
Service Code
|
APR-DRG 4621
|
| Min. Negotiated Rate |
$3,718.93 |
| Max. Negotiated Rate |
$3,718.93 |
| Rate for Payer: IEHP Medi-Cal |
$3,718.93
|
|
|
NEPHRITIS AND NEPHROSIS
|
Facility
IP
|
$22,621.95
|
|
|
Service Code
|
APR-DRG 4624
|
| Min. Negotiated Rate |
$22,621.95 |
| Max. Negotiated Rate |
$22,621.95 |
| Rate for Payer: IEHP Medi-Cal |
$22,621.95
|
|
|
Nerve graft (includes obtaining graft), head or neck; more than 4 cm length
|
Facility
OP
|
$15,813.78
|
|
|
Service Code
|
CPT 64886
|
| Min. Negotiated Rate |
$1,295.74 |
| Max. Negotiated Rate |
$15,813.78 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: Dignity Health Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,323.04
|
| Rate for Payer: Humana Medicare |
$8,323.04
|
| Rate for Payer: IEHP Medi-Cal |
$1,295.74
|
| Rate for Payer: IEHP Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,813.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,821.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,487.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,155.34
|
| Rate for Payer: TriValley Medical Group Senior |
$8,323.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
Nerve repair; with nerve allograft, each nerve, first strand (cable)
|
Facility
OP
|
$15,813.78
|
|
|
Service Code
|
CPT 64912
|
| Min. Negotiated Rate |
$210.83 |
| Max. Negotiated Rate |
$15,813.78 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: Dignity Health Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,323.04
|
| Rate for Payer: Humana Medicare |
$8,323.04
|
| Rate for Payer: IEHP Medi-Cal |
$210.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,813.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,821.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,487.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,155.34
|
| Rate for Payer: TriValley Medical Group Senior |
$8,323.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve
|
Facility
OP
|
$15,813.78
|
|
|
Service Code
|
CPT 64910
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$15,813.78 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: Dignity Health Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,323.04
|
| Rate for Payer: Humana Medicare |
$8,323.04
|
| Rate for Payer: IEHP Medi-Cal |
$179.35
|
| Rate for Payer: IEHP Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,813.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,821.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,487.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,155.34
|
| Rate for Payer: TriValley Medical Group Senior |
$8,323.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
IP
|
$9,186.87
|
|
|
Service Code
|
APR-DRG 0413
|
| Min. Negotiated Rate |
$9,186.87 |
| Max. Negotiated Rate |
$9,186.87 |
| Rate for Payer: IEHP Medi-Cal |
$9,186.87
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
IP
|
$13,591.27
|
|
|
Service Code
|
APR-DRG 0414
|
| Min. Negotiated Rate |
$13,591.27 |
| Max. Negotiated Rate |
$13,591.27 |
| Rate for Payer: IEHP Medi-Cal |
$13,591.27
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
IP
|
$6,955.32
|
|
|
Service Code
|
APR-DRG 0412
|
| Min. Negotiated Rate |
$6,955.32 |
| Max. Negotiated Rate |
$6,955.32 |
| Rate for Payer: IEHP Medi-Cal |
$6,955.32
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
IP
|
$6,239.99
|
|
|
Service Code
|
APR-DRG 0411
|
| Min. Negotiated Rate |
$6,239.99 |
| Max. Negotiated Rate |
$6,239.99 |
| Rate for Payer: IEHP Medi-Cal |
$6,239.99
|
|
|
Neuroplasty and/or transposition; cranial nerve (specify)
|
Facility
OP
|
$5,505.00
|
|
|
Service Code
|
CPT 64716
|
| Min. Negotiated Rate |
$622.02 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$622.02
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty and/or transposition; median nerve at carpal tunnel
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64721
|
| Min. Negotiated Rate |
$98.73 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$98.73
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty and/or transposition; ulnar nerve at elbow
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64718
|
| Min. Negotiated Rate |
$139.39 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$139.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty and/or transposition; ulnar nerve at wrist
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64719
|
| Min. Negotiated Rate |
$462.31 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$462.31
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty; digital, 1 or both, same digit
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64702
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$315.95
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64714
|
| Min. Negotiated Rate |
$157.39 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$157.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty, major peripheral nerve, arm or leg, open; other than specified
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64708
|
| Min. Negotiated Rate |
$696.95 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$696.95
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Neuroplasty; nerve of hand or foot
|
Facility
OP
|
$4,583.52
|
|
|
Service Code
|
CPT 64704
|
| Min. Negotiated Rate |
$92.93 |
| Max. Negotiated Rate |
$4,583.52 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$92.93
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,412.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
NEUROSTIM INSERT/REPL SEN LEAD
|
Facility
OP
|
$23,100.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906820304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,237.00 |
| Max. Negotiated Rate |
$19,635.00 |
| Rate for Payer: Adventist Health Commercial |
$4,620.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,869.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19,635.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,705.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17,325.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,015.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,635.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,635.00
|
| Rate for Payer: Dignity Health Senior |
$19,635.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,298.90
|
| Rate for Payer: Heritage Provider Network Senior |
$14,298.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,134.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,181.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,775.00
|
| Rate for Payer: Multiplan Commercial |
$17,325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,635.00
|
| Rate for Payer: Vantage Medical Group Senior |
$19,635.00
|
|
|
NEUROSTIM INSERT/REPL SEN LEAD
|
Facility
IP
|
$23,100.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906820304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,181.10 |
| Max. Negotiated Rate |
$17,325.00 |
| Rate for Payer: Adventist Health Commercial |
$4,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,869.70
|
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,638.70
|
| Rate for Payer: Heritage Provider Network Senior |
$15,638.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,181.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,775.00
|
| Rate for Payer: Multiplan Commercial |
$17,325.00
|
|
