|
PIOGLITAZONE 15 MG TABLET [25528]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 0781-5420-92
|
| Hospital Charge Code |
1710878
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
IP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
1712291
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
OP
|
$0.22
|
|
|
Service Code
|
NDC 33342-055-07
|
| Hospital Charge Code |
1712291
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
OP
|
$0.37
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM/50 ML IN DEXTROSE(ISO) IV PIGGYBACK [34523]
|
Facility
IP
|
$0.37
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
OP
|
$11.10
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
ERX18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Senior |
$9.44
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$7.84
|
| Rate for Payer: Dignity Health Senior |
$5.61
|
| Rate for Payer: Dignity Health Senior |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$3.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$6.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.84
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
IP
|
$11.10
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
ERX18304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.83
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6.24
|
| Rate for Payer: Heritage Provider Network Senior |
$7.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$6.92
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.08
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
IP
|
$0.48
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Senior |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG34524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Senior |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
OP
|
$0.49
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1753480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Senior |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1753480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
IP
|
$10.56
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.25
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.15
|
| Rate for Payer: Heritage Provider Network Senior |
$7.95
|
| Rate for Payer: Heritage Provider Network Senior |
$7.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.53
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
OP
|
$10.56
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.98
|
| Rate for Payer: Dignity Health Senior |
$9.98
|
| Rate for Payer: Dignity Health Senior |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$9.98
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK [108121]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
NDG108121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| 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 |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
IP
|
$13.32
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.66
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.86
|
| Rate for Payer: Heritage Provider Network Senior |
$11.86
|
| Rate for Payer: Heritage Provider Network Senior |
$9.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.58
|
| Rate for Payer: Heritage Provider Network Senior |
$11.37
|
| Rate for Payer: Heritage Provider Network Senior |
$11.33
|
| Rate for Payer: Heritage Provider Network Senior |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$6.18
|
| Rate for Payer: Multiplan Commercial |
$9.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.45
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [18302]
|
Facility
OP
|
$16.80
|
|
|
Service Code
|
CPT J2543
|
| Hospital Charge Code |
1721132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$1.65
|
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Senior |
$11.32
|
| Rate for Payer: Dignity Health Senior |
$14.22
|
| Rate for Payer: Dignity Health Senior |
$14.28
|
| Rate for Payer: Dignity Health Senior |
$14.89
|
| Rate for Payer: Dignity Health Senior |
$7.00
|
| Rate for Payer: Dignity Health Senior |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.78
|
| Rate for Payer: Heritage Provider Network Senior |
$7.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.11
|
| Rate for Payer: Heritage Provider Network Senior |
$3.82
|
| Rate for Payer: Heritage Provider Network Senior |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$6.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.22
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.32
|
|
|
Placement of amniotic membrane on the ocular surface; without sutures
|
Facility
OP
|
$3,237.00
|
|
|
Service Code
|
CPT 65778
|
| Min. Negotiated Rate |
$98.73 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: Dignity Health Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,264.97
|
| Rate for Payer: Humana Medicare |
$1,264.97
|
| Rate for Payer: IEHP Medi-Cal |
$98.73
|
| Rate for Payer: IEHP Medicare Advantage |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,403.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,492.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,593.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,391.47
|
| Rate for Payer: TriValley Medical Group Senior |
$1,264.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 50432
|
| Min. Negotiated Rate |
$1,206.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$1,206.88
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,799.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2,544.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
Placement of seton
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 46020
|
| Min. Negotiated Rate |
$300.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: IEHP Medi-Cal |
$300.27
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,858.96
|
| Rate for Payer: TriValley Medical Group Senior |
$3,508.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 54300
|
| Min. Negotiated Rate |
$526.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$526.19
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,355.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 54304
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$174.24
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,355.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Plastic operation on penis to correct angulation
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 54360
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$166.11
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,355.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication)
|
Facility
OP
|
$11,807.68
|
|
|
Service Code
|
CPT 57220
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$11,807.68 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,836.03
|
| Rate for Payer: Dignity Health Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,214.57
|
| Rate for Payer: Humana Medicare |
$6,214.57
|
| Rate for Payer: IEHP Medi-Cal |
$553.32
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,807.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,333.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,830.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,830.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,836.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6,214.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Plastic repair of canaliculi
|
Facility
OP
|
$5,547.37
|
|
|
Service Code
|
CPT 68700
|
| Min. Negotiated Rate |
$1,294.58 |
| Max. Negotiated Rate |
$5,547.37 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: IEHP Medi-Cal |
$1,294.58
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,547.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,211.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.67
|
| 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
|
|
