|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
IP
|
$6,480.67
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
ERX4081378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,296.13 |
| Max. Negotiated Rate |
$5,832.60 |
| Rate for Payer: Blue Shield of California Commercial |
$4,860.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,460.68
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,184.54
|
| Rate for Payer: Cigna of CA HMO |
$4,536.47
|
| Rate for Payer: Cigna of CA PPO |
$4,536.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,592.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,592.27
|
| Rate for Payer: Galaxy Health WC |
$5,508.57
|
| Rate for Payer: Global Benefits Group Commercial |
$3,888.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,832.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,322.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.13
|
| Rate for Payer: Multiplan Commercial |
$4,860.50
|
| Rate for Payer: Networks By Design Commercial |
$3,240.34
|
| Rate for Payer: Prime Health Services Commercial |
$5,508.57
|
|
|
Cervical lymphadenectomy (modified radical neck dissection)
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 38724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$10,844.95
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$9,100.66 |
| Max. Negotiated Rate |
$10,844.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,100.66
|
| Rate for Payer: IEHP medi-cal |
$10,844.95
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$8,579.86
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$7,199.88 |
| Max. Negotiated Rate |
$8,579.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,199.88
|
| Rate for Payer: IEHP medi-cal |
$8,579.86
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$7,043.54
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$5,910.66 |
| Max. Negotiated Rate |
$7,043.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,910.66
|
| Rate for Payer: IEHP medi-cal |
$7,043.54
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$20,045.85
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$16,821.70 |
| Max. Negotiated Rate |
$20,045.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,821.70
|
| Rate for Payer: IEHP medi-cal |
$20,045.85
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$11,717.88
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$9,833.18 |
| Max. Negotiated Rate |
$11,717.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,833.18
|
| Rate for Payer: IEHP medi-cal |
$11,717.88
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$8,291.54
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$6,957.94 |
| Max. Negotiated Rate |
$8,291.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,957.94
|
| Rate for Payer: IEHP medi-cal |
$8,291.54
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$7,178.36
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$6,023.80 |
| Max. Negotiated Rate |
$7,178.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,023.80
|
| Rate for Payer: IEHP medi-cal |
$7,178.36
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$26,673.49
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$22,383.35 |
| Max. Negotiated Rate |
$26,673.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,383.35
|
| Rate for Payer: IEHP medi-cal |
$26,673.49
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 45802-974-26
|
| Hospital Charge Code |
NDG70838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 45802-974-26
|
| Hospital Charge Code |
NDG70838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
OP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$73.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.43
|
| Rate for Payer: BCBS Transplant Transplant |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$87.98
|
| Rate for Payer: Blue Shield of California EPN |
$79.98
|
| Rate for Payer: Caremore Medicare Advantage |
$73.72
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.90
|
| Rate for Payer: IEHP medi-cal |
$121.64
|
| Rate for Payer: IEHP Medicare Advantage |
$73.72
|
| Rate for Payer: Innovage PACE Commercial |
$110.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.78
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Medicare |
$78.14
|
| Rate for Payer: Riverside University Health MISP |
$81.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other HMO |
$9.18
|
| Rate for Payer: United Healthcare HMO Rider |
$9.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$73.72
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
IP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Blue Shield of California Commercial |
$13.78
|
| Rate for Payer: Blue Shield of California EPN |
$9.81
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
OP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$73.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.43
|
| Rate for Payer: BCBS Transplant Transplant |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$87.98
|
| Rate for Payer: Blue Shield of California EPN |
$79.98
|
| Rate for Payer: Caremore Medicare Advantage |
$73.72
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$73.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.90
|
| Rate for Payer: IEHP medi-cal |
$121.64
|
| Rate for Payer: IEHP Medicare Advantage |
$73.72
|
| Rate for Payer: Innovage PACE Commercial |
$110.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.78
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Medicare |
$78.14
|
| Rate for Payer: Riverside University Health MISP |
$81.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other HMO |
$9.18
|
| Rate for Payer: United Healthcare HMO Rider |
$9.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$73.72
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
IP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Blue Shield of California Commercial |
$13.78
|
| Rate for Payer: Blue Shield of California EPN |
$9.81
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$12.86
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.61
|
| Rate for Payer: Global Benefits Group Commercial |
$11.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: Networks By Design Commercial |
$9.18
|
| Rate for Payer: Prime Health Services Commercial |
$15.61
|
|
|
CEVIMELINE 30 MG CAPSULE [27253]
|
Facility
IP
|
$9.77
|
|
|
Service Code
|
NDC 63395-201-13
|
| Hospital Charge Code |
1711933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Central Health Plan Commercial |
$7.82
|
| Rate for Payer: Cigna of CA HMO |
$6.84
|
| Rate for Payer: Cigna of CA PPO |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.33
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
|
|
CEVIMELINE 30 MG CAPSULE [27253]
|
Facility
OP
|
$9.77
|
|
|
Service Code
|
NDC 63395-201-13
|
| Hospital Charge Code |
1711933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.77
|
| Rate for Payer: BCBS Transplant Transplant |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Central Health Plan Commercial |
$7.82
|
| Rate for Payer: Cigna of CA HMO |
$6.84
|
| Rate for Payer: Cigna of CA PPO |
$6.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.91
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.33
|
| Rate for Payer: IEHP medi-cal |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.33
|
| Rate for Payer: Networks By Design Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: Riverside University Health MISP |
$3.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4.88
|
| Rate for Payer: United Healthcare HMO Rider |
$4.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
Change of cystostomy tube; simple
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: IEHP medi-cal |
$509.50
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Innovage PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health MISP |
$339.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
Chemodenervation of internal anal sphincter
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: IEHP medi-cal |
$610.60
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Innovage PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health MISP |
$407.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
Chemodenervation of one extremity; 1-4 muscle(s)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.04 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Chemodenervation of one extremity; 5 or more muscles
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.04 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
