|
RASAGILINE 0.5 MG TABLET [76480]
|
Facility
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-683-30
|
| Hospital Charge Code |
1711909
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.52
|
| Rate for Payer: BCBS Transplant Transplant |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.24
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.35
|
| Rate for Payer: IEHP medi-cal |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: Riverside University Health MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.87
|
| Rate for Payer: BCBS Transplant Transplant |
$4.95
|
| Rate for Payer: Blue Shield of California Commercial |
$5.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Central Health Plan Commercial |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.19
|
| Rate for Payer: IEHP medi-cal |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: Riverside University Health MISP |
$3.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.52
|
| Rate for Payer: BCBS Transplant Transplant |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.24
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.35
|
| Rate for Payer: IEHP medi-cal |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: Riverside University Health MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.90
|
| Rate for Payer: United Healthcare HMO Rider |
$8.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.13
|
| Rate for Payer: Vantage Medical Group Senior |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$17.80
|
|
|
Service Code
|
NDC 47781-690-30
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Blue Shield of California Commercial |
$13.35
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$8.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.24
|
| Rate for Payer: Cigna of CA HMO |
$12.46
|
| Rate for Payer: Cigna of CA PPO |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$15.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$11.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.13
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$8.25
|
|
|
Service Code
|
NDC 0093-3061-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.41
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Central Health Plan Commercial |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$5.78
|
| Rate for Payer: Cigna of CA PPO |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: Galaxy Health WC |
$7.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$6.19
|
| Rate for Payer: Networks By Design Commercial |
$5.36
|
| Rate for Payer: Prime Health Services Commercial |
$7.01
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$3.44
|
|
|
Service Code
|
NDC 23155-747-03
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.03
|
| Rate for Payer: BCBS Transplant Transplant |
$2.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.41
|
| Rate for Payer: Cigna of CA PPO |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.58
|
| Rate for Payer: IEHP medi-cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: Riverside University Health MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
IP
|
$41.81
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.63 |
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| Rate for Payer: Blue Shield of California EPN |
$22.33
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Central Health Plan Commercial |
$33.45
|
| Rate for Payer: Cigna of CA HMO |
$29.27
|
| Rate for Payer: Cigna of CA PPO |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.72
|
| Rate for Payer: Galaxy Health WC |
$35.54
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.54
|
|
|
RASAGILINE 1 MG TABLET [76481]
|
Facility
OP
|
$41.81
|
|
|
Service Code
|
NDC 68546-229-56
|
| Hospital Charge Code |
1711908
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.70
|
| Rate for Payer: BCBS Transplant Transplant |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Blue Shield of California EPN |
$20.45
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Central Health Plan Commercial |
$33.45
|
| Rate for Payer: Cigna of CA HMO |
$29.27
|
| Rate for Payer: Cigna of CA PPO |
$29.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.72
|
| Rate for Payer: Galaxy Health WC |
$35.54
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.36
|
| Rate for Payer: IEHP medi-cal |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: Riverside University Health MISP |
$16.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO |
$20.90
|
| Rate for Payer: United Healthcare HMO Rider |
$20.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.54
|
| Rate for Payer: Vantage Medical Group Senior |
$35.54
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
IP
|
$1,276.65
|
|
|
Service Code
|
CPT J2783
|
| Hospital Charge Code |
1722030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$1,148.98 |
| Rate for Payer: Blue Shield of California Commercial |
$957.49
|
| Rate for Payer: Blue Shield of California EPN |
$681.73
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Central Health Plan Commercial |
$1,021.32
|
| Rate for Payer: Cigna of CA HMO |
$893.66
|
| Rate for Payer: Cigna of CA PPO |
$893.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.66
|
| Rate for Payer: Galaxy Health WC |
$1,085.15
|
| Rate for Payer: Global Benefits Group Commercial |
$765.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,148.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.33
|
| Rate for Payer: Multiplan Commercial |
$957.49
|
| Rate for Payer: Networks By Design Commercial |
$638.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.15
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]
|
Facility
OP
|
$1,276.65
|
|
|
Service Code
|
CPT J2783
|
| Hospital Charge Code |
1722030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.86 |
| Max. Negotiated Rate |
$2,275.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$367.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,275.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$403.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$403.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.30
|
| Rate for Payer: BCBS Transplant Transplant |
$765.99
|
| Rate for Payer: Blue Shield of California Commercial |
$398.86
|
| Rate for Payer: Blue Shield of California EPN |
$362.60
|
| Rate for Payer: Caremore Medicare Advantage |
$367.27
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Cash Price |
$574.49
|
| Rate for Payer: Central Health Plan Commercial |
$1,021.32
|
| Rate for Payer: Cigna of CA HMO |
$893.66
|
| Rate for Payer: Cigna of CA PPO |
$893.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$367.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$367.27
|
| Rate for Payer: Galaxy Health WC |
$1,085.15
|
| Rate for Payer: Global Benefits Group Commercial |
$765.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,148.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$957.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$602.32
|
| Rate for Payer: IEHP medi-cal |
$605.99
|
| Rate for Payer: IEHP Medicare Advantage |
$367.27
|
| Rate for Payer: Innovage PACE Commercial |
$550.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.14
|
| Rate for Payer: Multiplan Commercial |
$957.49
|
| Rate for Payer: Networks By Design Commercial |
$638.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,085.15
|
| Rate for Payer: Prime Health Services Medicare |
$389.30
|
| Rate for Payer: Riverside University Health MISP |
$403.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.32
|
| Rate for Payer: United Healthcare All Other HMO |
$638.32
|
| Rate for Payer: United Healthcare HMO Rider |
$638.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$638.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$550.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$403.99
|
| Rate for Payer: Vantage Medical Group Senior |
$367.27
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
IP
|
$2,561.60
|
|
|
Service Code
|
CPT J1303
|
| Hospital Charge Code |
NDG229668A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$512.32 |
| Max. Negotiated Rate |
$2,305.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1,921.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,367.89
|
| Rate for Payer: Cash Price |
$1,152.72
|
| Rate for Payer: Central Health Plan Commercial |
$2,049.28
|
| Rate for Payer: Cigna of CA HMO |
$1,793.12
|
| Rate for Payer: Cigna of CA PPO |
$1,793.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,024.64
|
| Rate for Payer: Galaxy Health WC |
$2,177.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1,536.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,305.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.32
|
| Rate for Payer: Multiplan Commercial |
$1,921.20
|
| Rate for Payer: Networks By Design Commercial |
$1,280.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.36
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION [229668]
|
Facility
OP
|
$2,561.60
|
|
|
Service Code
|
CPT J1303
|
| Hospital Charge Code |
NDG229668A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.77 |
| Max. Negotiated Rate |
$2,305.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$221.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,374.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$243.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$422.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,536.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,611.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,252.62
|
| Rate for Payer: Caremore Medicare Advantage |
$221.77
|
| Rate for Payer: Cash Price |
$1,152.72
|
| Rate for Payer: Cash Price |
$1,152.72
|
| Rate for Payer: Central Health Plan Commercial |
$2,049.28
|
| Rate for Payer: Cigna of CA HMO |
$1,793.12
|
| Rate for Payer: Cigna of CA PPO |
$1,793.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$221.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$221.77
|
| Rate for Payer: Galaxy Health WC |
$2,177.36
|
| Rate for Payer: Global Benefits Group Commercial |
$1,536.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,305.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,921.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$363.71
|
| Rate for Payer: IEHP medi-cal |
$365.93
|
| Rate for Payer: IEHP Medicare Advantage |
$221.77
|
| Rate for Payer: Innovage PACE Commercial |
$332.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$297.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$297.18
|
| Rate for Payer: Multiplan Commercial |
$1,921.20
|
| Rate for Payer: Networks By Design Commercial |
$1,280.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.36
|
| Rate for Payer: Prime Health Services Medicare |
$235.08
|
| Rate for Payer: Riverside University Health MISP |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,536.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,536.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,280.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,280.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1,280.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,280.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
Realignment of extensor tendon, hand, each tendon
|
Facility
OP
|
$8,114.00
|
|
|
Service Code
|
CPT 26437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| 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: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| 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 |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft)
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 26541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,044.21 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 25337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
|
|
Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21142
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,960.28 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| 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: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
|
|
Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21143
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| 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 |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| 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 |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 21145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| 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: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
|
|
Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure)
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| 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: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67973
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| 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: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| 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: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
