|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Senior |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Senior |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
IP
|
$12.16
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.35
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Senior |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
OP
|
$12.16
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7.55
|
| Rate for Payer: Blue Shield of California EPN |
$7.14
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.34
|
| Rate for Payer: Dignity Health Senior |
$10.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.34
|
| Rate for Payer: Vantage Medical Group Senior |
$10.34
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
IP
|
$24.36
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Adventist Health Commercial |
$4.86
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.70
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.46
|
| Rate for Payer: Heritage Provider Network Senior |
$16.46
|
| Rate for Payer: Heritage Provider Network Senior |
$12.88
|
| Rate for Payer: Heritage Provider Network Senior |
$16.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$18.27
|
| Rate for Payer: Multiplan Commercial |
$18.23
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.14
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
OP
|
$24.36
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$20.71 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Adventist Health Commercial |
$4.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.71
|
| Rate for Payer: Dignity Health Senior |
$20.71
|
| Rate for Payer: Dignity Health Senior |
$16.18
|
| Rate for Payer: Dignity Health Senior |
$20.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.28
|
| Rate for Payer: Heritage Provider Network Senior |
$11.26
|
| Rate for Payer: Heritage Provider Network Senior |
$11.28
|
| Rate for Payer: Heritage Provider Network Senior |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$18.23
|
| Rate for Payer: Multiplan Commercial |
$18.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.71
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$20.71
|
| Rate for Payer: Vantage Medical Group Senior |
$20.66
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
IP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$27.38 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.08
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.71
|
| Rate for Payer: Heritage Provider Network Senior |
$24.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.19
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Senior |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Senior |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
Evisceration of ocular contents; with implant
|
Facility
OP
|
$9,178.50
|
|
|
Service Code
|
CPT 65093
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$9,178.50 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: Dignity Health Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,830.79
|
| Rate for Payer: Humana Medicare |
$4,830.79
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$4,830.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,178.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,700.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,086.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,086.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,313.87
|
| Rate for Payer: TriValley Medical Group Senior |
$4,830.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
Exchange of intraocular lens
|
Facility
OP
|
$8,576.00
|
|
|
Service Code
|
CPT 66986
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$8,576.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| 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 |
$8,576.00
|
| 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 |
$157.98
|
| 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
|
|
|
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin
|
Facility
OP
|
$5,547.37
|
|
|
Service Code
|
CPT 67966
|
| Min. Negotiated Rate |
$720.75 |
| Max. Negotiated Rate |
$5,547.37 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 |
$5,505.00
|
| 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 |
$720.75
|
| 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
|
|
|
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin
|
Facility
OP
|
$5,547.37
|
|
|
Service Code
|
CPT 67961
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$5,547.37 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| 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 |
$5,505.00
|
| 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 |
$130.68
|
| 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
|
|
|
Excision aural glomus tumor; transmastoid
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 69552
|
| Min. Negotiated Rate |
$1,844.58 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$1,844.58
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11420
|
| Min. Negotiated Rate |
$83.05 |
| 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 |
$83.05
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11421
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$104.54
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11422
|
| Min. Negotiated Rate |
$115.58 |
| 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 |
$115.58
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11423
|
| Min. Negotiated Rate |
$135.33 |
| 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 |
$135.33
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11426
|
| Min. Negotiated Rate |
$374.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| 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 |
$4,547.00
|
| 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 |
$374.60
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11400
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$90.60
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11402
|
| Min. Negotiated Rate |
$112.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$112.09
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11403
|
| Min. Negotiated Rate |
$285.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$285.29
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11404
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$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 |
$138.23
|
| 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
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11406
|
| Min. Negotiated Rate |
$452.17 |
| 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 |
$452.17
|
| 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
|
|
|
Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 42815
|
| Min. Negotiated Rate |
$658.04 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$658.04
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Excision distal ulna partial or complete (eg, Darrach type or matched resection)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25240
|
| Min. Negotiated Rate |
$394.93 |
| 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 |
$394.93
|
| 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
|
|
|
Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15847
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
|
