|
HC SOM GANGLIOSIDE AB IGM DISIALO
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GANGLIOSIDE AB IGM MONO
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GANGLIOSIDE AB IGM MONO
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.60
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| 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: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: IEHP medi-cal |
$19.02
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Innovage PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$12.68
|
| 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: 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 GASTRIN
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$156.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.52
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.91
|
| Rate for Payer: IEHP medi-cal |
$29.09
|
| Rate for Payer: IEHP Medicare Advantage |
$17.63
|
| Rate for Payer: Innovage PACE Commercial |
$26.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.62
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$18.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health MISP |
$19.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.28
|
| Rate for Payer: United Healthcare All Other HMO |
$14.28
|
| Rate for Payer: United Healthcare HMO Rider |
$14.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Vantage Medical Group Senior |
$17.63
|
|
|
HC SOM GASTRIN
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM GHIVR 87901
|
Facility
IP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$331.86 |
| Rate for Payer: Cash Price |
$165.93
|
| Rate for Payer: Central Health Plan Commercial |
$294.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.49
|
| Rate for Payer: Galaxy Health WC |
$313.42
|
| Rate for Payer: Global Benefits Group Commercial |
$221.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.75
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
| Rate for Payer: Networks By Design Commercial |
$239.67
|
| Rate for Payer: Prime Health Services Commercial |
$313.42
|
|
|
HC SOM GHIVR 87901
|
Facility
OP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$2,282.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$257.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,889.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$283.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,871.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,282.96
|
| Rate for Payer: BCBS Transplant Transplant |
$221.24
|
| Rate for Payer: Blue Shield of California Commercial |
$227.88
|
| Rate for Payer: Blue Shield of California EPN |
$179.20
|
| Rate for Payer: Caremore Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$165.93
|
| Rate for Payer: Cash Price |
$165.93
|
| Rate for Payer: Central Health Plan Commercial |
$294.98
|
| Rate for Payer: Cigna of CA HMO |
$235.99
|
| Rate for Payer: Cigna of CA PPO |
$272.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$257.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.45
|
| Rate for Payer: Galaxy Health WC |
$313.42
|
| Rate for Payer: Global Benefits Group Commercial |
$221.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$276.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$422.22
|
| Rate for Payer: IEHP medi-cal |
$424.79
|
| Rate for Payer: IEHP Medicare Advantage |
$257.45
|
| Rate for Payer: Innovage PACE Commercial |
$386.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
| Rate for Payer: Networks By Design Commercial |
$239.67
|
| Rate for Payer: Prime Health Services Commercial |
$313.42
|
| Rate for Payer: Prime Health Services Medicare |
$272.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$221.24
|
| Rate for Payer: Riverside University Health MISP |
$283.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.54
|
| Rate for Payer: United Healthcare All Other HMO |
$208.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.20
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$82.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.74
|
| Rate for Payer: BCBS Transplant Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: IEHP medi-cal |
$19.77
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Innovage PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: Riverside University Health MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| 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: 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 GIARDIA LAMBIA AG
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGA
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915374
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGA
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915374
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.73
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGG
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.73
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGG
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM GLUCAGON
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$107.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.65
|
| Rate for Payer: BCBS Transplant Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$18.47
|
| Rate for Payer: Caremore Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.29
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.44
|
| Rate for Payer: IEHP medi-cal |
$23.58
|
| Rate for Payer: IEHP Medicare Advantage |
$14.29
|
| Rate for Payer: Innovage PACE Commercial |
$21.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$15.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: Riverside University Health MISP |
$15.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.57
|
| Rate for Payer: United Healthcare All Other HMO |
$11.57
|
| Rate for Payer: United Healthcare HMO Rider |
$11.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Vantage Medical Group Senior |
$14.29
|
|
|
HC SOM GLUCAGON
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
OP
|
$22.64
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$86.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.03
|
| Rate for Payer: BCBS Transplant Transplant |
$13.58
|
| Rate for Payer: Blue Shield of California Commercial |
$13.99
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Caremore Medicare Advantage |
$9.70
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Central Health Plan Commercial |
$18.11
|
| Rate for Payer: Cigna of CA HMO |
$14.49
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.91
|
| Rate for Payer: IEHP medi-cal |
$16.00
|
| Rate for Payer: IEHP Medicare Advantage |
$9.70
|
| Rate for Payer: Innovage PACE Commercial |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$16.98
|
| Rate for Payer: Networks By Design Commercial |
$14.72
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Medicare |
$10.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: Riverside University Health MISP |
$10.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Vantage Medical Group Senior |
$9.70
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
IP
|
$22.64
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Central Health Plan Commercial |
$18.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.06
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.98
|
| Rate for Payer: Networks By Design Commercial |
$14.72
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
IP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Central Health Plan Commercial |
$22.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Global Benefits Group Commercial |
$16.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Networks By Design Commercial |
$17.94
|
| Rate for Payer: Prime Health Services Commercial |
$23.46
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
OP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: BCBS Transplant Transplant |
$16.56
|
| Rate for Payer: Blue Shield of California Commercial |
$17.06
|
| Rate for Payer: Blue Shield of California EPN |
$13.41
|
| Rate for Payer: Caremore Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Central Health Plan Commercial |
$22.08
|
| Rate for Payer: Cigna of CA HMO |
$17.66
|
| Rate for Payer: Cigna of CA PPO |
$20.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Global Benefits Group Commercial |
$16.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: IEHP medi-cal |
$38.89
|
| Rate for Payer: IEHP Medicare Advantage |
$23.57
|
| Rate for Payer: Innovage PACE Commercial |
$35.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Networks By Design Commercial |
$17.94
|
| Rate for Payer: Prime Health Services Commercial |
$23.46
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.56
|
| Rate for Payer: Riverside University Health MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.56
|
| 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: Vantage Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GROWTH HORMONE
|
Facility
IP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Central Health Plan Commercial |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$10.71
|
| Rate for Payer: Global Benefits Group Commercial |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: Networks By Design Commercial |
$8.19
|
| Rate for Payer: Prime Health Services Commercial |
$10.71
|
|
|
HC SOM GROWTH HORMONE
|
Facility
OP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$147.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.86
|
| Rate for Payer: BCBS Transplant Transplant |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$7.79
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Caremore Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Central Health Plan Commercial |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.67
|
| Rate for Payer: Galaxy Health WC |
$10.71
|
| Rate for Payer: Global Benefits Group Commercial |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.34
|
| Rate for Payer: IEHP medi-cal |
$27.51
|
| Rate for Payer: IEHP Medicare Advantage |
$16.67
|
| Rate for Payer: Innovage PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.34
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: Networks By Design Commercial |
$8.19
|
| Rate for Payer: Prime Health Services Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Medicare |
$17.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.56
|
| Rate for Payer: Riverside University Health MISP |
$18.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Vantage Medical Group Senior |
$16.67
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.10
|
| Rate for Payer: BCBS Transplant Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.08
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Caremore Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.88
|
| Rate for Payer: IEHP medi-cal |
$26.04
|
| Rate for Payer: IEHP Medicare Advantage |
$15.78
|
| Rate for Payer: Innovage PACE Commercial |
$23.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$16.73
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$17.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.78
|
| Rate for Payer: United Healthcare All Other HMO |
$12.78
|
| Rate for Payer: United Healthcare HMO Rider |
$12.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Vantage Medical Group Senior |
$15.78
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM HANDLING FEE
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM HANDLING FEE
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$87.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.04
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: IEHP medi-cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Riverside University Health MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
