|
Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36821
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$138.23
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
ARTESUNATE 110 MG INTRAVENOUS SOLUTION [230847]
|
Facility
OP
|
$5,976.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX230847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,081.66 |
| Max. Negotiated Rate |
$5,079.60 |
| Rate for Payer: Adventist Health Commercial |
$1,195.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,194.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,105.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,079.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,286.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,482.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,711.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,507.91
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,748.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,079.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,079.60
|
| Rate for Payer: Dignity Health Senior |
$5,079.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,824.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,766.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,766.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,880.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,494.00
|
| Rate for Payer: Multiplan Commercial |
$4,482.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,178.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,996.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,079.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,079.60
|
|
|
ARTESUNATE 110 MG INTRAVENOUS SOLUTION [230847]
|
Facility
IP
|
$5,976.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX230847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,081.66 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$1,195.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,105.51
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,748.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,227.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,045.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,045.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,494.00
|
| Rate for Payer: Multiplan Commercial |
$4,482.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,178.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,996.58
|
|
|
Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 20605
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$9,616.00 |
| 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 |
$4,547.00
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$59.23
|
| 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
|
|
|
Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 20610
|
| Min. Negotiated Rate |
$71.43 |
| Max. Negotiated Rate |
$9,616.00 |
| 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 |
$5,505.00
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$71.43
|
| 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
|
|
|
Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 20600
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$9,616.00 |
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$50.53
|
| 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
|
|
|
Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
|
Facility
OP
|
$31,243.54
|
|
|
Service Code
|
CPT 22551
|
| Min. Negotiated Rate |
$443.94 |
| Max. Negotiated Rate |
$31,243.54 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Dignity Health Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,443.97
|
| Rate for Payer: Humana Medicare |
$16,443.97
|
| Rate for Payer: IEHP Medi-Cal |
$443.94
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,243.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,403.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,719.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,088.37
|
| Rate for Payer: TriValley Medical Group Senior |
$16,443.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 22552
|
| Min. Negotiated Rate |
$512.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$512.88
|
|
|
Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 26841
|
| Min. Negotiated Rate |
$527.94 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$527.94
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar;
|
Facility
OP
|
$44,240.59
|
|
|
Service Code
|
CPT 22633
|
| Min. Negotiated Rate |
$2,363.15 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$2,363.15
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$23,284.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
Arthrodesis, interphalangeal joint, with or without internal fixation;
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26860
|
| Min. Negotiated Rate |
$414.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$414.10
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26861
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$29.05
|
|
|
Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 26862
|
| Min. Negotiated Rate |
$550.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$550.59
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
Arthrodesis, metacarpophalangeal joint, with or without internal fixation;
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 26850
|
| Min. Negotiated Rate |
$513.41 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$513.41
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar;
|
Facility
OP
|
$44,240.59
|
|
|
Service Code
|
CPT 22630
|
| Min. Negotiated Rate |
$1,754.56 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$1,754.56
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$23,284.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 22632
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$83.05
|
|
|
Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 segment
|
Facility
OP
|
$10,742.00
|
|
|
Service Code
|
CPT 22600
|
| Min. Negotiated Rate |
$1,491.47 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$1,491.47
|
|
|
Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 22614
|
| Min. Negotiated Rate |
$102.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$102.21
|
|
|
Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed)
|
Facility
OP
|
$44,240.59
|
|
|
Service Code
|
CPT 22612
|
| Min. Negotiated Rate |
$1,860.27 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$1,860.27
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$23,284.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device
|
Facility
OP
|
$44,240.59
|
|
|
Service Code
|
CPT 27279
|
| Min. Negotiated Rate |
$151.59 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$151.59
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$23,284.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints)
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 25800
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal)
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 25820
|
| Min. Negotiated Rate |
$789.30 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$789.30
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Arthrodesis, wrist; with autograft (includes obtaining graft)
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 25825
|
| Min. Negotiated Rate |
$189.34 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$189.34
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft)
|
Facility
OP
|
$31,243.54
|
|
|
Service Code
|
CPT 25810
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$31,243.54 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Dignity Health Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,443.97
|
| Rate for Payer: Humana Medicare |
$16,443.97
|
| Rate for Payer: IEHP Medi-Cal |
$210.24
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,243.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,403.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,719.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,088.37
|
| Rate for Payer: TriValley Medical Group Senior |
$16,443.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft
|
Facility
OP
|
$24,665.96
|
|
|
Service Code
|
CPT 27130
|
| Min. Negotiated Rate |
$2,323.15 |
| Max. Negotiated Rate |
$24,665.96 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Dignity Health Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,443.97
|
| Rate for Payer: Humana Medicare |
$16,443.97
|
| Rate for Payer: IEHP Medi-Cal |
$2,323.15
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,561.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,403.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,719.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,088.37
|
| Rate for Payer: TriValley Medical Group Senior |
$16,443.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
