|
Otoplasty, protruding ear, with or without size reduction
|
Facility
OP
|
$7,643.11
|
|
|
Service Code
|
CPT 69300
|
| Min. Negotiated Rate |
$580.79 |
| Max. Negotiated Rate |
$7,643.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$580.79
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,424.96
|
| Rate for Payer: TriValley Medical Group Senior |
$4,022.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
Outdated MS-DRG 222
|
Facility
IP
|
$124,959.75
|
|
|
Service Code
|
MS-DRG 222
|
| Min. Negotiated Rate |
$13,987.00 |
| Max. Negotiated Rate |
$124,959.75 |
| Rate for Payer: Aetna of CA Gatekeeper |
$28,979.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,987.00
|
| Rate for Payer: Multiplan WC |
$124,959.75
|
|
|
Outdated MS-DRG 223
|
Facility
IP
|
$85,171.94
|
|
|
Service Code
|
MS-DRG 223
|
| Min. Negotiated Rate |
$11,000.00 |
| Max. Negotiated Rate |
$85,171.94 |
| Rate for Payer: Aetna of CA Gatekeeper |
$28,979.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,987.00
|
| Rate for Payer: Multiplan WC |
$85,171.94
|
|
|
Outdated MS-DRG 224
|
Facility
IP
|
$115,699.49
|
|
|
Service Code
|
MS-DRG 224
|
| Min. Negotiated Rate |
$11,000.00 |
| Max. Negotiated Rate |
$115,699.49 |
| Rate for Payer: Aetna of CA Gatekeeper |
$28,979.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,987.00
|
| Rate for Payer: Multiplan WC |
$115,699.49
|
|
|
Outdated MS-DRG 225
|
Facility
IP
|
$82,544.33
|
|
|
Service Code
|
MS-DRG 225
|
| Min. Negotiated Rate |
$11,000.00 |
| Max. Negotiated Rate |
$82,544.33 |
| Rate for Payer: Aetna of CA Gatekeeper |
$28,979.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,987.00
|
| Rate for Payer: Multiplan WC |
$82,544.33
|
|
|
Outdated MS-DRG 226
|
Facility
IP
|
$104,466.07
|
|
|
Service Code
|
MS-DRG 226
|
| Min. Negotiated Rate |
$11,000.00 |
| Max. Negotiated Rate |
$104,466.07 |
| Rate for Payer: Aetna of CA Gatekeeper |
$28,979.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,987.00
|
| Rate for Payer: Multiplan WC |
$104,466.07
|
|
|
Outdated MS-DRG 227
|
Facility
IP
|
$81,940.48
|
|
|
Service Code
|
MS-DRG 227
|
| Min. Negotiated Rate |
$11,000.00 |
| Max. Negotiated Rate |
$81,940.48 |
| Rate for Payer: Aetna of CA Gatekeeper |
$28,979.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,987.00
|
| Rate for Payer: Multiplan WC |
$81,940.48
|
|
|
Outdated MS-DRG 230
|
Facility
IP
|
$86,939.00
|
|
|
Service Code
|
MS-DRG 230
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$86,939.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$86,939.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,410.00
|
|
|
Outdated MS-DRG 237
|
Facility
IP
|
$32,400.00
|
|
|
Service Code
|
MS-DRG 237
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$32,400.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$32,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,410.00
|
|
|
Outdated MS-DRG 238
|
Facility
IP
|
$32,400.00
|
|
|
Service Code
|
MS-DRG 238
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$32,400.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$32,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,410.00
|
|
|
Outdated MS-DRG 246
|
Facility
IP
|
$48,886.51
|
|
|
Service Code
|
MS-DRG 246
|
| Min. Negotiated Rate |
$8,633.00 |
| Max. Negotiated Rate |
$48,886.51 |
| Rate for Payer: Aetna of CA Gatekeeper |
$14,118.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,633.00
|
| Rate for Payer: Multiplan WC |
$48,886.51
|
|
|
Outdated MS-DRG 247
|
Facility
IP
|
$31,164.05
|
|
|
Service Code
|
MS-DRG 247
|
| Min. Negotiated Rate |
$8,633.00 |
| Max. Negotiated Rate |
$31,164.05 |
| Rate for Payer: Aetna of CA Gatekeeper |
$14,118.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,633.00
|
| Rate for Payer: Multiplan WC |
$31,164.05
|
|
|
Outdated MS-DRG 248
|
Facility
IP
|
$49,121.53
|
|
|
Service Code
|
MS-DRG 248
|
| Min. Negotiated Rate |
$8,633.00 |
| Max. Negotiated Rate |
$49,121.53 |
| Rate for Payer: Aetna of CA Gatekeeper |
$14,118.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,633.00
|
| Rate for Payer: Multiplan WC |
$49,121.53
|
|
|
Outdated MS-DRG 249
|
Facility
IP
|
$29,649.51
|
|
|
Service Code
|
MS-DRG 249
|
| Min. Negotiated Rate |
$8,633.00 |
| Max. Negotiated Rate |
$29,649.51 |
| Rate for Payer: Aetna of CA Gatekeeper |
$14,118.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,633.00
|
| Rate for Payer: Multiplan WC |
$29,649.51
|
|
|
Outdated MS-DRG 338
|
Facility
IP
|
$43,355.48
|
|
|
Service Code
|
MS-DRG 338
|
| Min. Negotiated Rate |
$43,355.48 |
| Max. Negotiated Rate |
$43,355.48 |
| Rate for Payer: Multiplan WC |
$43,355.48
|
|
|
Outdated MS-DRG 339
|
Facility
IP
|
$26,576.35
|
|
|
Service Code
|
MS-DRG 339
|
| Min. Negotiated Rate |
$26,576.35 |
| Max. Negotiated Rate |
$26,576.35 |
| Rate for Payer: Multiplan WC |
$26,576.35
|
|
|
Outdated MS-DRG 340
|
Facility
IP
|
$19,583.00
|
|
|
Service Code
|
MS-DRG 340
|
| Min. Negotiated Rate |
$19,583.00 |
| Max. Negotiated Rate |
$19,583.00 |
| Rate for Payer: Multiplan WC |
$19,583.00
|
|
|
Outdated MS-DRG 341
|
Facility
IP
|
$36,868.07
|
|
|
Service Code
|
MS-DRG 341
|
| Min. Negotiated Rate |
$36,868.07 |
| Max. Negotiated Rate |
$36,868.07 |
| Rate for Payer: Multiplan WC |
$36,868.07
|
|
|
Outdated MS-DRG 342
|
Facility
IP
|
$23,716.99
|
|
|
Service Code
|
MS-DRG 343
|
| Min. Negotiated Rate |
$23,716.99 |
| Max. Negotiated Rate |
$23,716.99 |
| Rate for Payer: Multiplan WC |
$23,716.99
|
|
|
Outdated MS-DRG 343
|
Facility
IP
|
$17,833.44
|
|
|
Service Code
|
MS-DRG 343
|
| Min. Negotiated Rate |
$17,833.44 |
| Max. Negotiated Rate |
$17,833.44 |
| Rate for Payer: Multiplan WC |
$17,833.44
|
|
|
Outdated MS-DRG 490
|
Facility
IP
|
$28,410.00
|
|
|
Service Code
|
MS-DRG 490
|
| Min. Negotiated Rate |
$21,600.00 |
| Max. Negotiated Rate |
$28,410.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$21,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,410.00
|
|
|
Outdated MS-DRG 491
|
Facility
IP
|
$28,410.00
|
|
|
Service Code
|
MS-DRG 491
|
| Min. Negotiated Rate |
$21,600.00 |
| Max. Negotiated Rate |
$28,410.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$21,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,410.00
|
|
|
Ovarian cystectomy, unilateral or bilateral
|
Facility
OP
|
$11,807.68
|
|
|
Service Code
|
CPT 58925
|
| Min. Negotiated Rate |
$189.71 |
| Max. Negotiated Rate |
$11,807.68 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,836.03
|
| Rate for Payer: Dignity Health Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,214.57
|
| Rate for Payer: Humana Medicare |
$6,214.57
|
| Rate for Payer: IEHP Medi-Cal |
$189.71
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,807.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,333.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,830.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,830.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,836.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6,214.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
OP
|
$133.20
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
ERX5925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.14
|
| Rate for Payer: Dignity Health Senior |
$113.22
|
| Rate for Payer: Dignity Health Senior |
$119.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.67
|
| Rate for Payer: Heritage Provider Network Senior |
$64.89
|
| Rate for Payer: Heritage Provider Network Senior |
$61.67
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$105.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.22
|
| Rate for Payer: Vantage Medical Group Senior |
$113.22
|
| Rate for Payer: Vantage Medical Group Senior |
$119.14
|
|
|
OXACILLIN 10 GRAM SOLUTION FOR INJECTION [5925]
|
Facility
IP
|
$140.16
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
ERX5925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$105.12 |
| Rate for Payer: Adventist Health Commercial |
$28.03
|
| Rate for Payer: Adventist Health Commercial |
$26.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.29
|
| Rate for Payer: Cash Price |
$59.94
|
| Rate for Payer: Cash Price |
$63.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.18
|
| Rate for Payer: Heritage Provider Network Senior |
$90.18
|
| Rate for Payer: Heritage Provider Network Senior |
$94.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$105.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.50
|
|
