|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-08
|
| Hospital Charge Code |
NDG10000B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.47
|
| Rate for Payer: Blue Distinction Transplant |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Media |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$150.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.61
|
| Rate for Payer: Blue Distinction Transplant |
$54.24
|
| Rate for Payer: Blue Shield of California Commercial |
$66.62
|
| Rate for Payer: Blue Shield of California EPN |
$90.40
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cigna of CA HMO |
$63.28
|
| Rate for Payer: Cigna of CA PPO |
$63.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.92
|
| Rate for Payer: Dignity Health Media |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.61
|
| Rate for Payer: Galaxy Health WC |
$76.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$124.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.66
|
| Rate for Payer: Multiplan Commercial |
$72.32
|
| Rate for Payer: Networks By Design Commercial |
$45.20
|
| Rate for Payer: Prime Health Services Commercial |
$76.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.20
|
| Rate for Payer: United Healthcare All Other HMO |
$45.20
|
| Rate for Payer: United Healthcare HMO Rider |
$45.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: Vantage Medical Group Senior |
$76.61
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$76.84 |
| Rate for Payer: Blue Shield of California Commercial |
$64.36
|
| Rate for Payer: Blue Shield of California EPN |
$46.28
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cigna of CA HMO |
$63.28
|
| Rate for Payer: Cigna of CA PPO |
$63.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.16
|
| Rate for Payer: Galaxy Health WC |
$76.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$72.32
|
| Rate for Payer: Networks By Design Commercial |
$45.20
|
| Rate for Payer: Prime Health Services Commercial |
$76.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.14
|
| Rate for Payer: United Healthcare All Other HMO |
$33.34
|
| Rate for Payer: United Healthcare HMO Rider |
$32.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.83
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Blue Distinction Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Media |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
OP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.75
|
| Rate for Payer: Blue Distinction Transplant |
$8.81
|
| Rate for Payer: Blue Shield of California Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California EPN |
$8.58
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.49
|
| Rate for Payer: Dignity Health Media |
$12.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$11.75
|
| Rate for Payer: Networks By Design Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Vantage Medical Group Senior |
$12.49
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
IP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.52
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$11.75
|
| Rate for Payer: Networks By Design Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
OP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.50
|
| Rate for Payer: Blue Distinction Transplant |
$17.62
|
| Rate for Payer: Blue Shield of California Commercial |
$21.65
|
| Rate for Payer: Blue Shield of California EPN |
$17.15
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cigna of CA HMO |
$20.56
|
| Rate for Payer: Cigna of CA PPO |
$20.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.96
|
| Rate for Payer: Dignity Health Media |
$24.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.75
|
| Rate for Payer: Galaxy Health WC |
$24.96
|
| Rate for Payer: Global Benefits Group Commercial |
$17.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$23.50
|
| Rate for Payer: Networks By Design Commercial |
$19.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.68
|
| Rate for Payer: United Healthcare All Other HMO |
$14.68
|
| Rate for Payer: United Healthcare HMO Rider |
$14.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.96
|
| Rate for Payer: Vantage Medical Group Senior |
$24.96
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
IP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.04
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cigna of CA HMO |
$20.56
|
| Rate for Payer: Cigna of CA PPO |
$20.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.75
|
| Rate for Payer: Galaxy Health WC |
$24.96
|
| Rate for Payer: Global Benefits Group Commercial |
$17.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$23.50
|
| Rate for Payer: Networks By Design Commercial |
$19.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.96
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
IP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Blue Shield of California Commercial |
$25.99
|
| Rate for Payer: Blue Shield of California EPN |
$18.69
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.20
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO |
$13.46
|
| Rate for Payer: United Healthcare HMO Rider |
$13.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.04
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Blue Distinction Transplant |
$21.90
|
| Rate for Payer: Blue Shield of California Commercial |
$26.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Media |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.20
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
OP
|
$12.16
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Blue Distinction Transplant |
$7.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cigna of CA HMO |
$8.51
|
| Rate for Payer: Cigna of CA PPO |
$8.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Media |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$9.73
|
| Rate for Payer: Networks By Design Commercial |
$7.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.08
|
| Rate for Payer: United Healthcare All Other HMO |
$6.08
|
| Rate for Payer: United Healthcare HMO Rider |
$6.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.34
|
| Rate for Payer: Vantage Medical Group Senior |
$10.34
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
IP
|
$12.16
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Blue Shield of California Commercial |
$8.66
|
| Rate for Payer: Blue Shield of California EPN |
$6.23
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cigna of CA HMO |
$8.51
|
| Rate for Payer: Cigna of CA PPO |
$8.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$9.73
|
| Rate for Payer: Networks By Design Commercial |
$7.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
OP
|
$24.31
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Blue Distinction Transplant |
$14.62
|
| Rate for Payer: Blue Distinction Transplant |
$11.42
|
| Rate for Payer: Blue Distinction Transplant |
$14.59
|
| Rate for Payer: Blue Shield of California Commercial |
$17.92
|
| Rate for Payer: Blue Shield of California Commercial |
$14.03
|
| Rate for Payer: Blue Shield of California Commercial |
$17.95
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cigna of CA HMO |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$17.02
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$17.05
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.18
|
| Rate for Payer: Dignity Health Media |
$16.18
|
| Rate for Payer: Dignity Health Media |
$20.66
|
| Rate for Payer: Dignity Health Media |
$20.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.71
|
| Rate for Payer: Galaxy Health WC |
$20.66
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Global Benefits Group Commercial |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$14.59
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Multiplan Commercial |
$19.49
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$19.45
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$12.16
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$20.71
|
| Rate for Payer: Prime Health Services Commercial |
$20.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.52
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.16
|
| Rate for Payer: United Healthcare All Other HMO |
$9.52
|
| Rate for Payer: United Healthcare HMO Rider |
$9.52
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$20.71
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$20.66
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
IP
|
$19.03
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Blue Shield of California Commercial |
$13.55
|
| Rate for Payer: Blue Shield of California Commercial |
$17.31
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| Rate for Payer: Blue Shield of California EPN |
$12.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.47
|
| Rate for Payer: Blue Shield of California EPN |
$9.74
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cigna of CA HMO |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$17.02
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Cigna of CA PPO |
$17.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.72
|
| Rate for Payer: Galaxy Health WC |
$20.66
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$20.71
|
| Rate for Payer: Global Benefits Group Commercial |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Global Benefits Group Commercial |
$14.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$19.45
|
| Rate for Payer: Multiplan Commercial |
$19.49
|
| Rate for Payer: Networks By Design Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$20.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.19
|
| Rate for Payer: United Healthcare All Other HMO |
$8.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.02
|
| Rate for Payer: United Healthcare All Other HMO |
$8.98
|
| Rate for Payer: United Healthcare HMO Rider |
$8.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6.87
|
| Rate for Payer: United Healthcare HMO Rider |
$8.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.04
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
IP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Blue Shield of California Commercial |
$25.99
|
| Rate for Payer: Blue Shield of California EPN |
$18.69
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.20
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO |
$13.46
|
| Rate for Payer: United Healthcare HMO Rider |
$13.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.04
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.71
|
| Rate for Payer: Blue Distinction Transplant |
$21.90
|
| Rate for Payer: Blue Shield of California Commercial |
$26.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Media |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.20
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 11420
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 11421
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
|
Facility
|
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 11422
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 11426
|
| Min. Negotiated Rate |
$456.25 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,751.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less
|
Facility
|
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 11400
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm
|
Facility
|
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 11402
|
| Min. Negotiated Rate |
$136.52 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm
|
Facility
|
OP
|
$5,938.00
|
|
|
Service Code
|
CPT 11404
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 11406
|
| Min. Negotiated Rate |
$550.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
