|
HC SOM FREE FATTY ACIDS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$131.53 |
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: EPIC Health Plan Senior |
$18.77
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.53
|
| Rate for Payer: Blue Shield of California Commercial |
$21.41
|
| Rate for Payer: Blue Shield of California EPN |
$14.14
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.77
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.77
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cigna of CA HMO |
$5.93
|
| Rate for Payer: Cigna of CA PPO |
$6.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$7.88
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.88
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.88
|
|
|
HC SOM FRUCTOSAMINE
|
Facility
|
IP
|
$16.04
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
900913929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.42
|
| Rate for Payer: Galaxy Health WC |
$13.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Multiplan Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$13.63
|
|
|
HC SOM FRUCTOSAMINE
|
Facility
|
OP
|
$16.04
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
900913929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$148.89 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.09
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Cigna of CA HMO |
$10.27
|
| Rate for Payer: Cigna of CA PPO |
$11.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.63
|
| Rate for Payer: EPIC Health Plan Senior |
$16.76
|
| Rate for Payer: Galaxy Health WC |
$13.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.46
|
| Rate for Payer: Multiplan Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$13.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.57
|
| Rate for Payer: United Healthcare All Other HMO |
$13.57
|
| Rate for Payer: United Healthcare HMO Rider |
$13.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16.76
|
|
|
HC SOM FSUCC 82491
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$123.77
|
| Rate for Payer: Blue Shield of California EPN |
$81.77
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FSUCC 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC SOM FUNGITELL ASSAY
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900912985
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC SOM FUNGITELL ASSAY
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900912985
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$86.97
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM GABAPENTIN (NEURONTIN)
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
900910415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.73
|
| Rate for Payer: Blue Shield of California Commercial |
$12.71
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.55
|
| Rate for Payer: United Healthcare All Other HMO |
$17.55
|
| Rate for Payer: United Healthcare HMO Rider |
$17.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.67
|
|
|
HC SOM GABAPENTIN (NEURONTIN)
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
900910415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
HC SOM GAD 65 ANTIBODIES
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900912683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Adventist Health Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$7.23
|
| Rate for Payer: Galaxy Health WC |
$15.37
|
| Rate for Payer: Global Benefits Group Commercial |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Multiplan Commercial |
$14.46
|
| Rate for Payer: Networks By Design Commercial |
$11.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.37
|
|
|
HC SOM GAD 65 ANTIBODIES
|
Facility
|
OP
|
$18.08
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900912683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$151.88 |
| Rate for Payer: Adventist Health Commercial |
$3.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.88
|
| Rate for Payer: Blue Shield of California Commercial |
$12.10
|
| Rate for Payer: Blue Shield of California EPN |
$7.99
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cigna of CA HMO |
$11.57
|
| Rate for Payer: Cigna of CA PPO |
$13.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$15.37
|
| Rate for Payer: Global Benefits Group Commercial |
$10.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$14.46
|
| Rate for Payer: Networks By Design Commercial |
$11.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GAL-1-PO4 URIDYL TR
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
900911057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$208.14 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.14
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.44
|
| Rate for Payer: EPIC Health Plan Senior |
$21.07
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.23
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.06
|
| Rate for Payer: United Healthcare All Other HMO |
$17.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Vantage Medical Group Senior |
$21.07
|
|
|
HC SOM GAL-1-PO4 URIDYL TR
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
900911057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM GALACTOSE 1 PHOSPHATE ERYTHRO
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
900910746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.24
|
| Rate for Payer: Blue Shield of California Commercial |
$117.08
|
| Rate for Payer: Blue Shield of California EPN |
$77.35
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GALACTOSE 1 PHOSPHATE ERYTHRO
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
900910746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM GANGLIOSIDE AB IGG ASIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GANGLIOSIDE AB IGG ASIALO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GANGLIOSIDE AB IGG DISIALO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912816
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GANGLIOSIDE AB IGG DISIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912816
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GANGLIOSIDE AB IGG MONO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GANGLIOSIDE AB IGG MONO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GANGLIOSIDE AB IGM ASIALO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
