|
TPN: NICU STARTER [196140]
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
NDC 9999-1961-40
|
| Hospital Charge Code |
NDC196140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.32 |
| Max. Negotiated Rate |
$374.25 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.81
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.82
|
| Rate for Payer: Heritage Provider Network Senior |
$337.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.75
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
|
|
TPN: NICU STARTER [196140]
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
NDC 9999-1961-40
|
| Hospital Charge Code |
NDC196140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.32 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$266.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Blue Shield of California Commercial |
$309.88
|
| Rate for Payer: Blue Shield of California EPN |
$292.91
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$324.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Senior |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.88
|
| Rate for Payer: Heritage Provider Network Senior |
$308.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$240.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.75
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [211543]
|
Facility
OP
|
$3,866.89
|
|
|
Service Code
|
CPT J9352
|
| Hospital Charge Code |
ERX211543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.24 |
| Max. Negotiated Rate |
$2,900.17 |
| Rate for Payer: Adventist Health Commercial |
$773.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$666.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,656.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$423.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$372.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$372.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.06
|
| Rate for Payer: Blue Shield of California Commercial |
$322.24
|
| Rate for Payer: Blue Shield of California EPN |
$322.24
|
| Rate for Payer: Cash Price |
$1,740.10
|
| Rate for Payer: Cash Price |
$1,740.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,778.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.24
|
| Rate for Payer: Dignity Health Senior |
$372.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,474.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$338.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,790.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,790.37
|
| Rate for Payer: Humana Medicare |
$338.40
|
| Rate for Payer: IEHP Medi-Cal |
$534.86
|
| Rate for Payer: IEHP Medicare Advantage |
$338.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$642.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$399.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$426.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$426.38
|
| Rate for Payer: Multiplan Commercial |
$2,900.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$372.24
|
| Rate for Payer: TriValley Medical Group Senior |
$338.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.24
|
| Rate for Payer: Vantage Medical Group Senior |
$338.40
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [211543]
|
Facility
IP
|
$3,866.89
|
|
|
Service Code
|
CPT J9352
|
| Hospital Charge Code |
ERX211543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$699.91 |
| Max. Negotiated Rate |
$2,900.17 |
| Rate for Payer: Adventist Health Commercial |
$773.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,656.55
|
| Rate for Payer: Cash Price |
$1,740.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,778.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,617.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,617.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.72
|
| Rate for Payer: Multiplan Commercial |
$2,900.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.93
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS [18266]
|
Facility
IP
|
$4.86
|
|
|
Service Code
|
NDC 0517-9203-25
|
| Hospital Charge Code |
NDG18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.34
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
|
|
TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML INTRAVENOUS [18266]
|
Facility
OP
|
$4.86
|
|
|
Service Code
|
NDC 0517-9203-25
|
| Hospital Charge Code |
NDG18266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.85
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: Dignity Health Senior |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
TRACE ELEMENTS CHOLESTASIS [4080051]
|
Facility
OP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-51
|
| Hospital Charge Code |
ERX4080051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.70
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Senior |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS CHOLESTASIS [4080051]
|
Facility
IP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-51
|
| Hospital Charge Code |
ERX4080051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
|
|
TRACE ELEMENTS FULL TERM [4080053]
|
Facility
IP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-53
|
| Hospital Charge Code |
ERX4080053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
|
|
TRACE ELEMENTS FULL TERM [4080053]
|
Facility
OP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-53
|
| Hospital Charge Code |
ERX4080053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.70
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Senior |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS PRETERM [4080052]
|
Facility
OP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-52
|
| Hospital Charge Code |
ERX4080052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.70
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Senior |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
TRACE ELEMENTS PRETERM [4080052]
|
Facility
IP
|
$6.30
|
|
|
Service Code
|
NDC 9994-0800-52
|
| Hospital Charge Code |
ERX4080052
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.33
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
|
|
Trachelectomy (cervicectomy), amputation of cervix (separate procedure)
|
Facility
OP
|
$11,807.68
|
|
|
Service Code
|
CPT 57530
|
| Min. Negotiated Rate |
$528.18 |
| Max. Negotiated Rate |
$11,807.68 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 |
$5,505.00
|
| 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 |
$528.18
|
| 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
|
|
|
Tracheostoma revision; complex, with flap rotation
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 31614
|
| Min. Negotiated Rate |
$493.68 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 |
$4,547.00
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$493.68
|
| 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
|
|
|
Tracheostoma revision; simple, without flap rotation
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31613
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$350.80
|
| 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
|
|
|
Tracheostomy, planned (separate procedure);
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31600
|
| Min. Negotiated Rate |
$313.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$313.62
|
| 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
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
IP
|
$131,776.96
|
|
|
Service Code
|
APR-DRG 0044
|
| Min. Negotiated Rate |
$131,776.96 |
| Max. Negotiated Rate |
$131,776.96 |
| Rate for Payer: IEHP Medi-Cal |
$131,776.96
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
IP
|
$41,400.61
|
|
|
Service Code
|
APR-DRG 0041
|
| Min. Negotiated Rate |
$41,400.61 |
| Max. Negotiated Rate |
$41,400.61 |
| Rate for Payer: IEHP Medi-Cal |
$41,400.61
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
IP
|
$90,178.37
|
|
|
Service Code
|
APR-DRG 0043
|
| Min. Negotiated Rate |
$90,178.37 |
| Max. Negotiated Rate |
$90,178.37 |
| Rate for Payer: IEHP Medi-Cal |
$90,178.37
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
IP
|
$61,998.93
|
|
|
Service Code
|
APR-DRG 0042
|
| Min. Negotiated Rate |
$61,998.93 |
| Max. Negotiated Rate |
$61,998.93 |
| Rate for Payer: IEHP Medi-Cal |
$61,998.93
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
IP
|
$46,809.86
|
|
|
Service Code
|
APR-DRG 0052
|
| Min. Negotiated Rate |
$46,809.86 |
| Max. Negotiated Rate |
$46,809.86 |
| Rate for Payer: IEHP Medi-Cal |
$46,809.86
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
IP
|
$38,871.59
|
|
|
Service Code
|
APR-DRG 0051
|
| Min. Negotiated Rate |
$38,871.59 |
| Max. Negotiated Rate |
$38,871.59 |
| Rate for Payer: IEHP Medi-Cal |
$38,871.59
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
IP
|
$86,843.48
|
|
|
Service Code
|
APR-DRG 0054
|
| Min. Negotiated Rate |
$86,843.48 |
| Max. Negotiated Rate |
$86,843.48 |
| Rate for Payer: IEHP Medi-Cal |
$86,843.48
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
IP
|
$63,950.91
|
|
|
Service Code
|
APR-DRG 0053
|
| Min. Negotiated Rate |
$63,950.91 |
| Max. Negotiated Rate |
$63,950.91 |
| Rate for Payer: IEHP Medi-Cal |
$63,950.91
|
|
|
Tracheotomy tube change prior to establishment of fistula tract
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31502
|
| Min. Negotiated Rate |
$92.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: IEHP Medi-Cal |
$92.93
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$579.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.71
|
| Rate for Payer: TriValley Medical Group Senior |
$305.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
