|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
OP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
NDG27770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$42.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.93
|
| Rate for Payer: BCBS Transplant Transplant |
$28.37
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$23.12
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Central Health Plan Commercial |
$37.82
|
| Rate for Payer: Cigna of CA HMO |
$33.10
|
| Rate for Payer: Cigna of CA PPO |
$33.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$40.19
|
| Rate for Payer: Global Benefits Group Commercial |
$28.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.46
|
| Rate for Payer: IEHP medi-cal |
$16.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.46
|
| Rate for Payer: Multiplan Commercial |
$35.46
|
| Rate for Payer: Networks By Design Commercial |
$30.73
|
| Rate for Payer: Prime Health Services Commercial |
$40.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.37
|
| Rate for Payer: Riverside University Health MISP |
$18.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO |
$23.64
|
| Rate for Payer: United Healthcare HMO Rider |
$23.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.19
|
| Rate for Payer: Vantage Medical Group Senior |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY [27770]
|
Facility
IP
|
$47.28
|
|
|
Service Code
|
NDC 24208-342-05
|
| Hospital Charge Code |
NDG27770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$35.46
|
| Rate for Payer: Blue Shield of California EPN |
$25.25
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Central Health Plan Commercial |
$37.82
|
| Rate for Payer: Cigna of CA HMO |
$33.10
|
| Rate for Payer: Cigna of CA PPO |
$33.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.91
|
| Rate for Payer: Galaxy Health WC |
$40.19
|
| Rate for Payer: Global Benefits Group Commercial |
$28.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.46
|
| Rate for Payer: Multiplan Commercial |
$35.46
|
| Rate for Payer: Networks By Design Commercial |
$30.73
|
| Rate for Payer: Prime Health Services Commercial |
$40.19
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
IP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
1740263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.78
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Central Health Plan Commercial |
$23.64
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$20.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$25.12
|
| Rate for Payer: Global Benefits Group Commercial |
$17.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.91
|
| Rate for Payer: Multiplan Commercial |
$22.16
|
| Rate for Payer: Networks By Design Commercial |
$19.21
|
| Rate for Payer: Prime Health Services Commercial |
$25.12
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) [21135]
|
Facility
OP
|
$29.55
|
|
|
Service Code
|
NDC 47335-788-91
|
| Hospital Charge Code |
1740263
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.46
|
| Rate for Payer: BCBS Transplant Transplant |
$17.73
|
| Rate for Payer: Blue Shield of California Commercial |
$18.59
|
| Rate for Payer: Blue Shield of California EPN |
$14.45
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Central Health Plan Commercial |
$23.64
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$20.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$25.12
|
| Rate for Payer: Global Benefits Group Commercial |
$17.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.16
|
| Rate for Payer: IEHP medi-cal |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.91
|
| Rate for Payer: Multiplan Commercial |
$22.16
|
| Rate for Payer: Networks By Design Commercial |
$19.21
|
| Rate for Payer: Prime Health Services Commercial |
$25.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.73
|
| Rate for Payer: Riverside University Health MISP |
$11.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO |
$14.78
|
| Rate for Payer: United Healthcare HMO Rider |
$14.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.12
|
| Rate for Payer: Vantage Medical Group Senior |
$25.12
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
IP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
1712429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$2.57
|
|
|
DESMOPRESSIN 25 MCG 1/4 TAB [4080522]
|
Facility
OP
|
$3.02
|
|
|
Service Code
|
NDC 9994-0805-22
|
| Hospital Charge Code |
1712429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.78
|
| Rate for Payer: BCBS Transplant Transplant |
$1.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.26
|
| Rate for Payer: IEHP medi-cal |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$2.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.81
|
| Rate for Payer: Riverside University Health MISP |
$1.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Vantage Medical Group Senior |
$2.57
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
IP
|
$61.20
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1757507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California EPN |
$32.68
|
| Rate for Payer: Blue Shield of California EPN |
$33.64
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Central Health Plan Commercial |
$48.96
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$42.84
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA PPO |
$42.84
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$52.02
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Global Benefits Group Commercial |
$36.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Networks By Design Commercial |
$30.60
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Prime Health Services Commercial |
$52.02
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1757507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.45
|
| Rate for Payer: BCBS Transplant Transplant |
$37.80
|
| Rate for Payer: BCBS Transplant Transplant |
$36.72
|
| Rate for Payer: Blue Shield of California Commercial |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$17.93
|
| Rate for Payer: Blue Shield of California EPN |
$16.30
|
| Rate for Payer: Blue Shield of California EPN |
$16.30
|
| Rate for Payer: Caremore Medicare Advantage |
$6.33
|
| Rate for Payer: Caremore Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Central Health Plan Commercial |
$48.96
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$42.84
|
| Rate for Payer: Cigna of CA PPO |
$42.84
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Galaxy Health WC |
$52.02
|
| Rate for Payer: Global Benefits Group Commercial |
$36.72
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$47.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.38
|
| Rate for Payer: IEHP medi-cal |
$10.44
|
| Rate for Payer: IEHP medi-cal |
$10.44
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: Innovage PACE Commercial |
$9.49
|
| Rate for Payer: Innovage PACE Commercial |
$9.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$45.90
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Commercial |
$52.02
|
| Rate for Payer: Prime Health Services Medicare |
$6.71
|
| Rate for Payer: Prime Health Services Medicare |
$6.71
|
| Rate for Payer: Riverside University Health MISP |
$6.96
|
| Rate for Payer: Riverside University Health MISP |
$6.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.60
|
| Rate for Payer: United Healthcare All Other HMO |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO |
$30.60
|
| Rate for Payer: United Healthcare HMO Rider |
$30.60
|
| Rate for Payer: United Healthcare HMO Rider |
$31.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1720511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.45
|
| Rate for Payer: BCBS Transplant Transplant |
$42.85
|
| Rate for Payer: BCBS Transplant Transplant |
$41.76
|
| Rate for Payer: BCBS Transplant Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$17.93
|
| Rate for Payer: Blue Shield of California EPN |
$16.30
|
| Rate for Payer: Blue Shield of California EPN |
$16.30
|
| Rate for Payer: Blue Shield of California EPN |
$16.30
|
| Rate for Payer: Caremore Medicare Advantage |
$6.33
|
| Rate for Payer: Caremore Medicare Advantage |
$6.33
|
| Rate for Payer: Caremore Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Central Health Plan Commercial |
$55.68
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$49.99
|
| Rate for Payer: Cigna of CA HMO |
$48.72
|
| Rate for Payer: Cigna of CA PPO |
$49.99
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: Cigna of CA PPO |
$48.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Galaxy Health WC |
$59.16
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Global Benefits Group Commercial |
$41.76
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$47.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.38
|
| Rate for Payer: IEHP medi-cal |
$10.44
|
| Rate for Payer: IEHP medi-cal |
$10.44
|
| Rate for Payer: IEHP medi-cal |
$10.44
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$6.33
|
| Rate for Payer: Innovage PACE Commercial |
$9.49
|
| Rate for Payer: Innovage PACE Commercial |
$9.49
|
| Rate for Payer: Innovage PACE Commercial |
$9.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Networks By Design Commercial |
$35.71
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.16
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Medicare |
$6.71
|
| Rate for Payer: Prime Health Services Medicare |
$6.71
|
| Rate for Payer: Prime Health Services Medicare |
$6.71
|
| Rate for Payer: Riverside University Health MISP |
$6.96
|
| Rate for Payer: Riverside University Health MISP |
$6.96
|
| Rate for Payer: Riverside University Health MISP |
$6.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO |
$34.80
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$31.50
|
| Rate for Payer: United Healthcare HMO Rider |
$31.50
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6.33
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [9748]
|
Facility
IP
|
$69.60
|
|
|
Service Code
|
CPT J2597
|
| Hospital Charge Code |
1720511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.20
|
| Rate for Payer: Blue Shield of California Commercial |
$53.56
|
| Rate for Payer: Blue Shield of California EPN |
$33.64
|
| Rate for Payer: Blue Shield of California EPN |
$38.14
|
| Rate for Payer: Blue Shield of California EPN |
$37.17
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$55.68
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Cigna of CA HMO |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$48.72
|
| Rate for Payer: Cigna of CA HMO |
$49.99
|
| Rate for Payer: Cigna of CA PPO |
$49.99
|
| Rate for Payer: Cigna of CA PPO |
$44.10
|
| Rate for Payer: Cigna of CA PPO |
$48.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$59.16
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Global Benefits Group Commercial |
$41.76
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$34.80
|
| Rate for Payer: Networks By Design Commercial |
$35.71
|
| Rate for Payer: Prime Health Services Commercial |
$59.16
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
DESMOPRESSIN ORAL SOLUTION COMPOUND 10 MCG/ML [4080400]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 9994-0804-00
|
| Hospital Charge Code |
1715267
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
DESMOPRESSIN ORAL SOLUTION COMPOUND 10 MCG/ML [4080400]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 9994-0804-00
|
| Hospital Charge Code |
1715267
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
OP
|
$3.85
|
|
|
Service Code
|
NDC 51672-1281-3
|
| Hospital Charge Code |
1743247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.89
|
| Rate for Payer: IEHP medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: Riverside University Health MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
IP
|
$3.85
|
|
|
Service Code
|
NDC 51672-1281-3
|
| Hospital Charge Code |
1743247
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
OP
|
$3.85
|
|
|
Service Code
|
NDC 0168-0309-15
|
| Hospital Charge Code |
1743237
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.89
|
| Rate for Payer: IEHP medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: Riverside University Health MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
IP
|
$3.85
|
|
|
Service Code
|
NDC 0168-0309-15
|
| Hospital Charge Code |
1743237
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
IP
|
$3.85
|
|
|
Service Code
|
NDC 51672-1281-1
|
| Hospital Charge Code |
1743237
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.06
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
DESONIDE 0.05 % TOPICAL OINTMENT [9751]
|
Facility
OP
|
$3.85
|
|
|
Service Code
|
NDC 51672-1281-1
|
| Hospital Charge Code |
1743237
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.70
|
| Rate for Payer: Cigna of CA PPO |
$2.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.89
|
| Rate for Payer: IEHP medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: Riverside University Health MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
IP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
1743316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.63
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.47
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
|
|
DESOXIMETASONE 0.25 % TOPICAL CREAM [2296]
|
Facility
OP
|
$3.29
|
|
|
Service Code
|
NDC 45802-495-35
|
| Hospital Charge Code |
1743316
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: BCBS Transplant Transplant |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.63
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.47
|
| Rate for Payer: IEHP medi-cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.47
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2.80
|
|
|
Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64624
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$2,412.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: IEHP medi-cal |
$3,980.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Innovage PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health MISP |
$2,653.62
|
| 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 |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Destruction by neurolytic agent; other peripheral nerve or branch
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,138.83 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| 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 |
$1,138.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: IEHP medi-cal |
$1,879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Innovage PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health MISP |
$1,252.71
|
| 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 |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64634
|
|
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
|
|
|
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,412.38 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: IEHP medi-cal |
$3,980.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Innovage PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health MISP |
$2,653.62
|
| 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 |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 64636
|
|
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
|
|
