|
INPATIENT MS-DRG 982: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$40,935.15
|
|
|
Service Code
|
MS-DRG 982
|
| Min. Negotiated Rate |
$28,197.85 |
| Max. Negotiated Rate |
$40,935.15 |
| Rate for Payer: EPIC Health Plan Medicare |
$28,197.85
|
| Rate for Payer: Humana Medicare |
$28,197.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,197.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,273.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,529.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,529.29
|
| Rate for Payer: Multiplan WC |
$40,935.15
|
|
|
INPATIENT MS-DRG 983: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$27,258.54
|
|
|
Service Code
|
MS-DRG 983
|
| Min. Negotiated Rate |
$18,617.47 |
| Max. Negotiated Rate |
$27,258.54 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,617.47
|
| Rate for Payer: Humana Medicare |
$18,617.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,968.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,458.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,458.01
|
| Rate for Payer: Multiplan WC |
$27,258.54
|
|
|
INPATIENT MS-DRG 987: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$54,158.04
|
|
|
Service Code
|
MS-DRG 987
|
| Min. Negotiated Rate |
$38,227.55 |
| Max. Negotiated Rate |
$54,158.04 |
| Rate for Payer: EPIC Health Plan Medicare |
$38,227.55
|
| Rate for Payer: Humana Medicare |
$38,227.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,227.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,108.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,166.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,166.71
|
| Rate for Payer: Multiplan WC |
$54,158.04
|
|
|
INPATIENT MS-DRG 988: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$27,686.15
|
|
|
Service Code
|
MS-DRG 988
|
| Min. Negotiated Rate |
$19,313.37 |
| Max. Negotiated Rate |
$27,686.15 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,313.37
|
| Rate for Payer: Humana Medicare |
$19,313.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,789.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,334.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,334.85
|
| Rate for Payer: Multiplan WC |
$27,686.15
|
|
|
INPATIENT MS-DRG 989: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,991.75
|
|
|
Service Code
|
MS-DRG 989
|
| Min. Negotiated Rate |
$12,369.06 |
| Max. Negotiated Rate |
$17,991.75 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,369.06
|
| Rate for Payer: Humana Medicare |
$12,369.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,369.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,595.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,585.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,585.02
|
| Rate for Payer: Multiplan WC |
$17,991.75
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11981
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
|
Facility
|
OP
|
$9,652.00
|
|
|
Service Code
|
CPT 66183
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$9,652.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,620.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,588.00
|
| Rate for Payer: Dignity Health Senior |
$5,080.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,080.00
|
| Rate for Payer: Humana Medicare |
$5,080.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,652.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,994.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,400.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,400.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,588.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,080.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,080.00
|
|
|
Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device
|
Facility
|
OP
|
$12,407.40
|
|
|
Service Code
|
CPT 0449T
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$12,407.40 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: Dignity Health Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,530.21
|
| Rate for Payer: Humana Medicare |
$6,530.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,407.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,705.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,228.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,183.23
|
| Rate for Payer: TriValley Medical Group Senior |
$6,530.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
Insertion of breast implant on same day of mastectomy (ie, immediate)
|
Facility
|
OP
|
$15,480.57
|
|
|
Service Code
|
CPT 19340
|
| Min. Negotiated Rate |
$813.10 |
| Max. Negotiated Rate |
$15,480.57 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,962.44
|
| Rate for Payer: Dignity Health Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,147.67
|
| Rate for Payer: Humana Medicare |
$8,147.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$813.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,147.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,614.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,266.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,266.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,962.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8,147.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
|
Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 49440
|
| Min. Negotiated Rate |
$1,436.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,436.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,377.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff
|
Facility
|
OP
|
$47,886.27
|
|
|
Service Code
|
CPT 53445
|
| Min. Negotiated Rate |
$198.04 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 22853
|
| Min. Negotiated Rate |
$342.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.67
|
|
|
Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
|
Facility
|
OP
|
$8,576.00
|
|
|
Service Code
|
CPT 66985
|
| Min. Negotiated Rate |
$737.02 |
| Max. Negotiated Rate |
$8,576.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$737.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Insertion of intrauterine device (IUD)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 58300
|
| Min. Negotiated Rate |
$262.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.42
|
|
|
Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 57267
|
| Min. Negotiated Rate |
$341.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.13
|
|
|
Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
|
Facility
|
OP
|
$47,886.27
|
|
|
Service Code
|
CPT 54405
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis
|
Facility
|
OP
|
$41,186.22
|
|
|
Service Code
|
CPT 0308T
|
| Min. Negotiated Rate |
$2,869.00 |
| Max. Negotiated Rate |
$41,186.22 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,515.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23,844.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,676.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,515.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,844.66
|
| Rate for Payer: Dignity Health Senior |
$21,676.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,676.96
|
| Rate for Payer: Humana Medicare |
$21,676.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,676.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,186.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,578.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,312.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,312.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$23,844.66
|
| Rate for Payer: TriValley Medical Group Senior |
$21,676.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,515.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,844.66
|
| Rate for Payer: Vantage Medical Group Senior |
$21,676.96
|
|
|
Insertion of penile prosthesis; inflatable (self-contained)
|
Facility
|
OP
|
$47,886.27
|
|
|
Service Code
|
CPT 54401
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36561
|
| Min. Negotiated Rate |
$405.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36558
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
Insertion of tunneled intraperitoneal catheter for dialysis, open
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 49421
|
| Min. Negotiated Rate |
$408.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,322.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
Insertion or replacement of breast implant on separate day from mastectomy
|
Facility
|
OP
|
$22,378.12
|
|
|
Service Code
|
CPT 19342
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$22,378.12 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,666.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,955.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,777.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,666.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,955.76
|
| Rate for Payer: Dignity Health Senior |
$11,777.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11,777.96
|
| Rate for Payer: Humana Medicare |
$11,777.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,777.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22,378.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,897.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,840.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,840.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$12,955.76
|
| Rate for Payer: TriValley Medical Group Senior |
$11,777.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,666.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,955.76
|
| Rate for Payer: Vantage Medical Group Senior |
$11,777.96
|
|
|
Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays
|
Facility
|
OP
|
$73,715.61
|
|
|
Service Code
|
CPT 61886
|
| Min. Negotiated Rate |
$590.66 |
| Max. Negotiated Rate |
$73,715.61 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38,797.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,677.46
|
| Rate for Payer: Dignity Health Senior |
$38,797.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$38,797.69
|
| Rate for Payer: Humana Medicare |
$38,797.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$590.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,797.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73,715.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,781.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,885.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,885.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$42,677.46
|
| Rate for Payer: TriValley Medical Group Senior |
$38,797.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58,196.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,677.46
|
| Rate for Payer: Vantage Medical Group Senior |
$38,797.69
|
|
|
Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array
|
Facility
|
OP
|
$51,930.90
|
|
|
Service Code
|
CPT 61885
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$51,930.90 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,332.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,065.26
|
| Rate for Payer: Dignity Health Senior |
$27,332.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$27,332.05
|
| Rate for Payer: Humana Medicare |
$27,332.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,332.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51,930.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,251.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,438.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,438.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$30,065.26
|
| Rate for Payer: TriValley Medical Group Senior |
$27,332.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: Vantage Medical Group Senior |
$27,332.05
|
|
|
Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver
|
Facility
|
OP
|
$51,930.90
|
|
|
Service Code
|
CPT 64590
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$51,930.90 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,332.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,266.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,065.26
|
| Rate for Payer: Dignity Health Senior |
$27,332.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$27,332.05
|
| Rate for Payer: Humana Medicare |
$27,332.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,332.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51,930.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,251.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,438.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,438.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$30,065.26
|
| Rate for Payer: TriValley Medical Group Senior |
$27,332.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,998.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,065.26
|
| Rate for Payer: Vantage Medical Group Senior |
$27,332.05
|
|
