|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
OP
|
$0.04
|
|
|
Service Code
|
NDC 600053772
|
| Hospital Charge Code |
NDG118075A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 600053797
|
| Hospital Charge Code |
ERX118075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
CERAMIDES 1,3,6-II TOPICAL CREAM [118075]
|
Facility
IP
|
$0.04
|
|
|
Service Code
|
NDC 600053772
|
| Hospital Charge Code |
NDG118075A
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
IP
|
$6,480.67
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
ERX4081378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,173.00 |
| Max. Negotiated Rate |
$4,860.50 |
| Rate for Payer: Adventist Health Commercial |
$1,296.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,452.22
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,981.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,499.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,387.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,387.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,173.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.17
|
| Rate for Payer: Multiplan Commercial |
$4,860.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,362.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,165.19
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML)SUBCUTANEOUS. [4081378]
|
Facility
OP
|
$6,480.67
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
ERX4081378
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$4,860.50 |
| Rate for Payer: Adventist Health Commercial |
$1,296.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,452.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.44
|
| Rate for Payer: Blue Shield of California Commercial |
$13.01
|
| Rate for Payer: Blue Shield of California EPN |
$13.01
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Cash Price |
$2,916.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,981.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,147.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,000.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,000.55
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: IEHP Medi-Cal |
$14.48
|
| Rate for Payer: IEHP Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,173.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$4,860.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.30
|
| Rate for Payer: TriValley Medical Group Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,362.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,165.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
Cervical lymphadenectomy (modified radical neck dissection)
|
Facility
OP
|
$10,742.00
|
|
|
Service Code
|
CPT 38724
|
| Min. Negotiated Rate |
$249.74 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$249.74
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$8,083.53
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$8,083.53 |
| Max. Negotiated Rate |
$8,083.53 |
| Rate for Payer: IEHP Medi-Cal |
$8,083.53
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$5,250.06
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$5,250.06 |
| Max. Negotiated Rate |
$5,250.06 |
| Rate for Payer: IEHP Medi-Cal |
$5,250.06
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$14,941.65
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$14,941.65 |
| Max. Negotiated Rate |
$14,941.65 |
| Rate for Payer: IEHP Medi-Cal |
$14,941.65
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
IP
|
$6,395.19
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$6,395.19 |
| Max. Negotiated Rate |
$6,395.19 |
| Rate for Payer: IEHP Medi-Cal |
$6,395.19
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$8,734.19
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$8,734.19 |
| Max. Negotiated Rate |
$8,734.19 |
| Rate for Payer: IEHP Medi-Cal |
$8,734.19
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$6,180.29
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$6,180.29 |
| Max. Negotiated Rate |
$6,180.29 |
| Rate for Payer: IEHP Medi-Cal |
$6,180.29
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$19,881.70
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$19,881.70 |
| Max. Negotiated Rate |
$19,881.70 |
| Rate for Payer: IEHP Medi-Cal |
$19,881.70
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
IP
|
$5,350.55
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$5,350.55 |
| Max. Negotiated Rate |
$5,350.55 |
| Rate for Payer: IEHP Medi-Cal |
$5,350.55
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 45802-974-26
|
| Hospital Charge Code |
NDG70838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION [70838]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 45802-974-26
|
| Hospital Charge Code |
NDG70838
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Senior |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
IP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.62
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.44
|
| Rate for Payer: Heritage Provider Network Senior |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.14
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION [37989]
|
Facility
OP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.93
|
| Rate for Payer: Blue Shield of California Commercial |
$74.31
|
| Rate for Payer: Blue Shield of California EPN |
$74.31
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Senior |
$81.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.51
|
| Rate for Payer: Heritage Provider Network Senior |
$8.51
|
| Rate for Payer: Humana Medicare |
$73.72
|
| Rate for Payer: IEHP Medi-Cal |
$121.96
|
| Rate for Payer: IEHP Medicare Advantage |
$73.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.89
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$81.09
|
| Rate for Payer: TriValley Medical Group Senior |
$73.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$73.72
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
IP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.62
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.44
|
| Rate for Payer: Heritage Provider Network Senior |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.14
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION [108072]
|
Facility
OP
|
$18.37
|
|
|
Service Code
|
CPT J9055
|
| Hospital Charge Code |
1755767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.93
|
| Rate for Payer: Blue Shield of California Commercial |
$74.31
|
| Rate for Payer: Blue Shield of California EPN |
$74.31
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Senior |
$81.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.51
|
| Rate for Payer: Heritage Provider Network Senior |
$8.51
|
| Rate for Payer: Humana Medicare |
$73.72
|
| Rate for Payer: IEHP Medi-Cal |
$121.96
|
| Rate for Payer: IEHP Medicare Advantage |
$73.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.89
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$81.09
|
| Rate for Payer: TriValley Medical Group Senior |
$73.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$73.72
|
|
|
CEVIMELINE 30 MG CAPSULE [27253]
|
Facility
OP
|
$9.77
|
|
|
Service Code
|
NDC 63395-201-13
|
| Hospital Charge Code |
1711933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$5.73
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.30
|
| Rate for Payer: Dignity Health Senior |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.05
|
| Rate for Payer: Heritage Provider Network Senior |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$7.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
CEVIMELINE 30 MG CAPSULE [27253]
|
Facility
IP
|
$9.77
|
|
|
Service Code
|
NDC 63395-201-13
|
| Hospital Charge Code |
1711933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.71
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.61
|
| Rate for Payer: Heritage Provider Network Senior |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$7.33
|
|
|
Change of cystostomy tube; simple
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 51705
|
| Min. Negotiated Rate |
$91.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$91.76
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$308.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
Chemodenervation of internal anal sphincter
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 46505
|
| Min. Negotiated Rate |
$295.04 |
| 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 |
$295.04
|
| 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
|
|
|
Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)
|
Facility
OP
|
$3,237.00
|
|
|
Service Code
|
CPT 64615
|
| Min. Negotiated Rate |
$162.04 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$162.04
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$370.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
