|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$55.12 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.49
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.76
|
| Rate for Payer: Heritage Provider Network Senior |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$77.17
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Adventist Health Commercial |
$15.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.88
|
| Rate for Payer: Blue Shield of California Commercial |
$47.92
|
| Rate for Payer: Blue Shield of California EPN |
$45.30
|
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.59
|
| Rate for Payer: Dignity Health Senior |
$65.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.77
|
| Rate for Payer: Heritage Provider Network Senior |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.29
|
| Rate for Payer: Multiplan Commercial |
$57.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Vantage Medical Group Senior |
$65.59
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION [18398]
|
Facility
OP
|
$73.55
|
|
|
Service Code
|
NDC 67457-198-00
|
| Hospital Charge Code |
1737066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$62.52 |
| Rate for Payer: Adventist Health Commercial |
$14.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.16
|
| Rate for Payer: Blue Shield of California Commercial |
$45.67
|
| Rate for Payer: Blue Shield of California EPN |
$43.17
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.52
|
| Rate for Payer: Dignity Health Senior |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.53
|
| Rate for Payer: Heritage Provider Network Senior |
$45.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$110.32 |
| Rate for Payer: Adventist Health Commercial |
$29.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.06
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.59
|
| Rate for Payer: Heritage Provider Network Senior |
$99.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.78
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Adventist Health Commercial |
$29.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.32
|
| Rate for Payer: Blue Shield of California Commercial |
$91.35
|
| Rate for Payer: Blue Shield of California EPN |
$86.35
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.04
|
| Rate for Payer: Dignity Health Senior |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.05
|
| Rate for Payer: Heritage Provider Network Senior |
$91.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.78
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
OP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$125.04 |
| Rate for Payer: Adventist Health Commercial |
$29.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.32
|
| Rate for Payer: Blue Shield of California Commercial |
$91.35
|
| Rate for Payer: Blue Shield of California EPN |
$86.35
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$95.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.04
|
| Rate for Payer: Dignity Health Senior |
$125.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.05
|
| Rate for Payer: Heritage Provider Network Senior |
$91.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.78
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION [18400]
|
Facility
IP
|
$147.10
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
1737067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$110.32 |
| Rate for Payer: Adventist Health Commercial |
$29.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.06
|
| Rate for Payer: Cash Price |
$66.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.59
|
| Rate for Payer: Heritage Provider Network Senior |
$99.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.78
|
| Rate for Payer: Multiplan Commercial |
$110.32
|
|
|
Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session
|
Facility
OP
|
$47,886.27
|
|
|
Service Code
|
CPT 54410
|
| Min. Negotiated Rate |
$1,126.15 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: IEHP Medi-Cal |
$1,126.15
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 50387
|
| Min. Negotiated Rate |
$704.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 |
$4,547.00
|
| 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 |
$704.50
|
| 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
|
|
|
Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session
|
Facility
OP
|
$47,886.27
|
|
|
Service Code
|
CPT 53447
|
| Min. Negotiated Rate |
$184.69 |
| Max. Negotiated Rate |
$47,886.27 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,203.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,723.63
|
| Rate for Payer: Dignity Health Senior |
$25,203.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25,203.30
|
| Rate for Payer: Humana Medicare |
$25,203.30
|
| Rate for Payer: IEHP Medi-Cal |
$184.69
|
| Rate for Payer: IEHP Medicare Advantage |
$25,203.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47,886.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,739.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,756.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,756.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,723.63
|
| Rate for Payer: TriValley Medical Group Senior |
$25,203.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,723.63
|
| Rate for Payer: Vantage Medical Group Senior |
$25,203.30
|
|
|
Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 21029
|
| Min. Negotiated Rate |
$696.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$696.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,424.96
|
| Rate for Payer: TriValley Medical Group Senior |
$4,022.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
Removal foreign body from external auditory canal; with general anesthesia
|
Facility
OP
|
$3,848.81
|
|
|
Service Code
|
CPT 69205
|
| Min. Negotiated Rate |
$125.46 |
| Max. Negotiated Rate |
$3,848.81 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$125.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Removal impacted cerumen requiring instrumentation, unilateral
|
Facility
OP
|
$3,237.00
|
|
|
Service Code
|
CPT 69210
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$47.63
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
Removal, non-biodegradable drug delivery implant
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11982
|
| Min. Negotiated Rate |
$175.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: IEHP Medi-Cal |
$175.39
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$945.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$547.60
|
| Rate for Payer: TriValley Medical Group Senior |
$497.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
Removal of anal seton, other marker
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 46030
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$109.76
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,621.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,474.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
Removal of blood clot, anterior segment of eye
|
Facility
OP
|
$5,532.10
|
|
|
Service Code
|
CPT 65930
|
| Min. Negotiated Rate |
$173.08 |
| Max. Negotiated Rate |
$5,532.10 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$173.08
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Removal of corneal epithelium; with application of chelating agent (eg, EDTA)
|
Facility
OP
|
$5,547.37
|
|
|
Service Code
|
CPT 65436
|
| Min. Negotiated Rate |
$254.97 |
| Max. Negotiated Rate |
$5,547.37 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 |
$3,237.00
|
| 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 |
$254.97
|
| 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
|
|
|
Removal of embedded foreign body, vestibule of mouth; complicated
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 40805
|
| Min. Negotiated Rate |
$411.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$411.73
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,306.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$756.18
|
| Rate for Payer: TriValley Medical Group Senior |
$687.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
Removal of fecal impaction or foreign body (separate procedure) under anesthesia
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 45915
|
| Min. Negotiated Rate |
$321.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$321.17
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,621.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,474.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 57415
|
| Min. Negotiated Rate |
$247.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: IEHP Medi-Cal |
$247.56
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,421.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,296.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,906.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 20680
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$236.96
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,745.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,905.29
|
| Rate for Payer: TriValley Medical Group Senior |
$3,550.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
Removal of implanted material, anterior segment of eye
|
Facility
OP
|
$9,792.00
|
|
|
Service Code
|
CPT 65920
|
| Min. Negotiated Rate |
$804.40 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$804.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Removal of implanted material, posterior segment; extraocular
|
Facility
OP
|
$5,532.10
|
|
|
Service Code
|
CPT 67120
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$5,532.10 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$131.84
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Removal of implant from finger or hand
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26320
|
| Min. Negotiated Rate |
$460.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$460.56
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 20670
|
| Min. Negotiated Rate |
$180.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$180.63
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
