|
Coronary Surgery
|
Facility
IP
|
$67,589.00
|
|
|
Service Code
|
ICD 04104AB
|
| Min. Negotiated Rate |
$57,931.00 |
| Max. Negotiated Rate |
$67,589.00 |
| Rate for Payer: Blue Shield of California Commercial |
$67,589.00
|
| Rate for Payer: Blue Shield of California EPN |
$57,931.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$67,589.00
|
|
|
Service Code
|
ICD 02124JC
|
| Min. Negotiated Rate |
$9,881.00 |
| Max. Negotiated Rate |
$67,589.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,881.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67,589.00
|
| Rate for Payer: Blue Shield of California EPN |
$57,931.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$67,589.00
|
|
|
Service Code
|
ICD 021L0Z8
|
| Min. Negotiated Rate |
$9,881.00 |
| Max. Negotiated Rate |
$67,589.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,881.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67,589.00
|
| Rate for Payer: Blue Shield of California EPN |
$57,931.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$67,589.00
|
|
|
Service Code
|
ICD 04SU3ZZ
|
| Min. Negotiated Rate |
$57,931.00 |
| Max. Negotiated Rate |
$67,589.00 |
| Rate for Payer: Blue Shield of California Commercial |
$67,589.00
|
| Rate for Payer: Blue Shield of California EPN |
$57,931.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$67,589.00
|
|
|
Service Code
|
ICD 041C092
|
| Min. Negotiated Rate |
$57,931.00 |
| Max. Negotiated Rate |
$67,589.00 |
| Rate for Payer: Blue Shield of California Commercial |
$67,589.00
|
| Rate for Payer: Blue Shield of California EPN |
$57,931.00
|
|
|
Coronary Surgery
|
Facility
IP
|
$67,589.00
|
|
|
Service Code
|
ICD 041F4ZF
|
| Min. Negotiated Rate |
$57,931.00 |
| Max. Negotiated Rate |
$67,589.00 |
| Rate for Payer: Blue Shield of California Commercial |
$67,589.00
|
| Rate for Payer: Blue Shield of California EPN |
$57,931.00
|
|
|
Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28296
|
| Min. Negotiated Rate |
$624.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$624.92
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28285
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$315.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Correction of inverted nipples
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 19355
|
| Min. Negotiated Rate |
$4,547.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| 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 |
$4,547.00
|
| 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 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
|
|
|
Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)
|
Facility
OP
|
$7,436.00
|
|
|
Service Code
|
CPT 67912
|
| Min. Negotiated Rate |
$1,315.84 |
| Max. Negotiated Rate |
$7,436.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: IEHP Medi-Cal |
$1,315.84
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,547.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,211.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Correction of lid retraction
|
Facility
OP
|
$5,547.37
|
|
|
Service Code
|
CPT 67911
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$5,547.37 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: IEHP Medi-Cal |
$127.78
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,547.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,211.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery)
|
Facility
OP
|
$3,237.00
|
|
|
Service Code
|
CPT 67825
|
| Min. Negotiated Rate |
$234.08 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$234.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medi-Cal |
$243.94
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$691.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$400.38
|
| Rate for Payer: TriValley Medical Group Senior |
$363.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
IP
|
$8,168.16
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,478.44 |
| Max. Negotiated Rate |
$6,126.12 |
| Rate for Payer: Adventist Health Commercial |
$1,633.63
|
| Rate for Payer: Adventist Health Commercial |
$2,049.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,040.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,611.53
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,714.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,757.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,534.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,410.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,938.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,529.84
|
| Rate for Payer: Heritage Provider Network Senior |
$5,529.84
|
| Rate for Payer: Heritage Provider Network Senior |
$6,938.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,855.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,562.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.04
|
| Rate for Payer: Multiplan Commercial |
$6,126.12
|
| Rate for Payer: Multiplan Commercial |
$7,686.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,736.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,978.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,424.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,728.98
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL [9685]
|
Facility
OP
|
$10,248.72
|
|
|
Service Code
|
CPT J0801
|
| Hospital Charge Code |
NDG9685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,855.02 |
| Max. Negotiated Rate |
$10,060.65 |
| Rate for Payer: Adventist Health Commercial |
$2,049.74
|
| Rate for Payer: Adventist Health Commercial |
$1,633.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10,060.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10,060.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,040.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,611.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,119.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,504.85
|
| Rate for Payer: Blue Shield of California Commercial |
$6,364.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5,072.43
|
| Rate for Payer: Blue Shield of California EPN |
$6,016.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,794.71
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$3,675.67
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cash Price |
$4,611.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,714.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,757.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,504.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,504.85
|
| Rate for Payer: Dignity Health Senior |
$4,504.85
|
| Rate for Payer: Dignity Health Senior |
$4,504.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,559.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,227.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,095.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,095.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,781.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,745.16
|
| Rate for Payer: Heritage Provider Network Senior |
$4,745.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,781.86
|
| Rate for Payer: Humana Medicare |
$4,095.32
|
| Rate for Payer: Humana Medicare |
$4,095.32
|
| Rate for Payer: IEHP Medi-Cal |
$6,395.66
|
| Rate for Payer: IEHP Medi-Cal |
$6,395.66
|
| Rate for Payer: IEHP Medicare Advantage |
$4,095.32
|
| Rate for Payer: IEHP Medicare Advantage |
$4,095.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,781.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,781.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,855.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,832.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,832.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,160.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,160.10
|
| Rate for Payer: Multiplan Commercial |
$7,686.54
|
| Rate for Payer: Multiplan Commercial |
$6,126.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,504.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,504.85
|
| Rate for Payer: TriValley Medical Group Senior |
$4,095.32
|
| Rate for Payer: TriValley Medical Group Senior |
$4,095.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,978.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,736.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,728.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,424.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,142.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,504.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4,095.32
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
OP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$227.72 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.72
|
| Rate for Payer: Blue Shield of California Commercial |
$85.87
|
| Rate for Payer: Blue Shield of California EPN |
$85.87
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.80
|
| Rate for Payer: Dignity Health Senior |
$81.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.56
|
| Rate for Payer: Heritage Provider Network Senior |
$44.56
|
| Rate for Payer: IEHP Medi-Cal |
$49.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.06
|
| Rate for Payer: Multiplan Commercial |
$72.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.80
|
| Rate for Payer: Vantage Medical Group Senior |
$81.80
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [9686]
|
Facility
IP
|
$96.24
|
|
|
Service Code
|
CPT J0834
|
| Hospital Charge Code |
1754264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$72.18 |
| Rate for Payer: Adventist Health Commercial |
$19.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.12
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.15
|
| Rate for Payer: Heritage Provider Network Senior |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.06
|
| Rate for Payer: Multiplan Commercial |
$72.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.15
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
OP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$354.92 |
| Rate for Payer: Adventist Health Commercial |
$61.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$354.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$261.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$230.40
|
| Rate for Payer: Blue Shield of California Commercial |
$190.77
|
| Rate for Payer: Blue Shield of California EPN |
$180.33
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.12
|
| Rate for Payer: Dignity Health Senior |
$261.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.23
|
| Rate for Payer: Heritage Provider Network Senior |
$142.23
|
| Rate for Payer: IEHP Medi-Cal |
$227.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$112.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$102.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.12
|
| Rate for Payer: Vantage Medical Group Senior |
$261.12
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [239502]
|
Facility
IP
|
$307.20
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
NDG239502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Adventist Health Commercial |
$61.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.05
|
| Rate for Payer: Cash Price |
$138.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.97
|
| Rate for Payer: Heritage Provider Network Senior |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$112.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$102.64
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$58,113.86
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$58,113.86 |
| Max. Negotiated Rate |
$58,113.86 |
| Rate for Payer: IEHP Medi-Cal |
$58,113.86
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$26,887.06
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$26,887.06 |
| Max. Negotiated Rate |
$26,887.06 |
| Rate for Payer: IEHP Medi-Cal |
$26,887.06
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$30,757.21
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$30,757.21 |
| Max. Negotiated Rate |
$30,757.21 |
| Rate for Payer: IEHP Medi-Cal |
$30,757.21
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$34,627.36
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$34,627.36 |
| Max. Negotiated Rate |
$34,627.36 |
| Rate for Payer: IEHP Medi-Cal |
$34,627.36
|
|
|
Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft (eg, biological collagen, thermoplastic graft)
|
Facility
OP
|
$13,045.53
|
|
|
Service Code
|
CPT 36830
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$184.11
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion
|
Facility
OP
|
$5,505.00
|
|
|
Service Code
|
CPT 61790
|
| Min. Negotiated Rate |
$174.24 |
| 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 |
$174.24
|
| 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
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION [225907]
|
Facility
OP
|
$294.35
|
|
|
Service Code
|
NDC 0078-0883-61
|
| Hospital Charge Code |
NDG225907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Adventist Health Commercial |
$58.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$250.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$220.76
|
| Rate for Payer: Blue Shield of California Commercial |
$182.79
|
| Rate for Payer: Blue Shield of California EPN |
$172.78
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.20
|
| Rate for Payer: Dignity Health Senior |
$250.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.28
|
| Rate for Payer: Heritage Provider Network Senior |
$136.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$141.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.59
|
| Rate for Payer: Multiplan Commercial |
$220.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$107.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.20
|
| Rate for Payer: Vantage Medical Group Senior |
$250.20
|
|
