|
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 |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| 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: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System 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: 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 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 |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 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 |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| 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: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System 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: 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 |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 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 |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 ASIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| 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: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System 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: 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 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: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 DISIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| 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: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System 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: 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 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 |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| 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: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System 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: 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 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: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| 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: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| 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 GASTRIN
|
Facility
|
OP
|
$17.42
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$178.40 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care 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 |
$178.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California EPN |
$6.92
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Central Health Plan Commercial |
$13.94
|
| Rate for Payer: Cigna of CA HMO |
$11.15
|
| Rate for Payer: Cigna of CA PPO |
$12.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.09
|
| Rate for Payer: EPIC Health Plan Senior |
$19.39
|
| Rate for Payer: Galaxy Health WC |
$14.81
|
| Rate for Payer: Global Benefits Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.62
|
| Rate for Payer: Multiplan Commercial |
$13.06
|
| Rate for Payer: Networks By Design Commercial |
$11.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$14.81
|
| Rate for Payer: Prime Health Services Medicare |
$18.69
|
| Rate for Payer: Riverside University Health System MISP |
$19.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.45
|
| 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: Upland Medical Group Pediatric |
$17.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Vantage Medical Group Senior |
$17.63
|
|
|
HC SOM GASTRIN
|
Facility
|
IP
|
$17.42
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Central Health Plan Commercial |
$13.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.97
|
| Rate for Payer: Galaxy Health WC |
$14.81
|
| Rate for Payer: Global Benefits Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$13.06
|
| Rate for Payer: Networks By Design Commercial |
$11.32
|
| Rate for Payer: Prime Health Services Commercial |
$14.81
|
|
|
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 |
$2,602.06 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$257.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,889.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care 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 |
$2,602.06
|
| Rate for Payer: Blue Shield of California Commercial |
$232.30
|
| Rate for Payer: Blue Shield of California EPN |
$146.39
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Cash Price |
$368.73
|
| 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: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.79
|
| Rate for Payer: EPIC Health Plan Senior |
$283.19
|
| 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: Heritage Provider Network Commercial/Senior |
$422.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$393.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$434.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
| Rate for Payer: Networks By Design Commercial |
$239.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$257.45
|
| Rate for Payer: Prime Health Services Commercial |
$313.42
|
| Rate for Payer: Prime Health Services Medicare |
$272.90
|
| Rate for Payer: Riverside University Health System MISP |
$283.19
|
| 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: Upland Medical Group Pediatric |
$257.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
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: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Central Health Plan Commercial |
$294.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.49
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$234.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.55
|
| 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 GIARDIA LAMBIA AG
|
Facility
|
IP
|
$27.10
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.39 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Central Health Plan Commercial |
$21.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$20.32
|
| Rate for Payer: Networks By Design Commercial |
$17.61
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
OP
|
$27.10
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$94.30 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 Exchange |
$67.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.30
|
| Rate for Payer: Blue Shield of California Commercial |
$17.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.76
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Central Health Plan Commercial |
$21.68
|
| Rate for Payer: Cigna of CA HMO |
$17.34
|
| Rate for Payer: Cigna of CA PPO |
$20.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$20.32
|
| Rate for Payer: Networks By Design Commercial |
$17.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.26
|
| 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 GLIADIN(DEAMIDATED) AB, IGA
|
Facility
|
OP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915374
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care 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 |
$32.75
|
| Rate for Payer: Blue Shield of California Commercial |
$15.01
|
| Rate for Payer: Blue Shield of California EPN |
$9.46
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Central Health Plan Commercial |
$19.06
|
| Rate for Payer: Cigna of CA HMO |
$15.24
|
| Rate for Payer: Cigna of CA PPO |
$17.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$20.25
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.29
|
| 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 |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGA
|
Facility
|
IP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915374
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$21.44 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Central Health Plan Commercial |
$19.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.25
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$20.25
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGG
|
Facility
|
IP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$21.44 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Central Health Plan Commercial |
$19.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.53
|
| Rate for Payer: EPIC Health Plan Senior |
$9.53
|
| Rate for Payer: Galaxy Health WC |
$20.25
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$20.25
|
|
|
HC SOM GLIADIN(DEAMIDATED) AB, IGG
|
Facility
|
OP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care 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 |
$32.75
|
| Rate for Payer: Blue Shield of California Commercial |
$15.01
|
| Rate for Payer: Blue Shield of California EPN |
$9.46
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Central Health Plan Commercial |
$19.06
|
| Rate for Payer: Cigna of CA HMO |
$15.24
|
| Rate for Payer: Cigna of CA PPO |
$17.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$20.25
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.29
|
| 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 |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM GLUCAGON
|
Facility
|
IP
|
$45.20
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$40.68 |
| Rate for Payer: Adventist Health Commercial |
$9.04
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Central Health Plan Commercial |
$36.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.08
|
| Rate for Payer: EPIC Health Plan Senior |
$18.08
|
| Rate for Payer: Galaxy Health WC |
$38.42
|
| Rate for Payer: Global Benefits Group Commercial |
$27.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$33.90
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: Prime Health Services Commercial |
$38.42
|
|
|
HC SOM GLUCAGON
|
Facility
|
OP
|
$45.20
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$122.70 |
| Rate for Payer: Adventist Health Commercial |
$9.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Alpha Care 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 |
$122.70
|
| Rate for Payer: Blue Shield of California Commercial |
$28.48
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Central Health Plan Commercial |
$36.16
|
| Rate for Payer: Cigna of CA HMO |
$28.93
|
| Rate for Payer: Cigna of CA PPO |
$33.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$38.42
|
| Rate for Payer: Global Benefits Group Commercial |
$27.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$33.90
|
| Rate for Payer: Networks By Design Commercial |
$29.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.29
|
| Rate for Payer: Prime Health Services Commercial |
$38.42
|
| Rate for Payer: Prime Health Services Medicare |
$15.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.12
|
| 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: Upland Medical Group Pediatric |
$14.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Vantage Medical Group Senior |
$14.29
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
OP
|
$31.80
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$98.05 |
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Alpha Care 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 |
$98.05
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$12.62
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Central Health Plan Commercial |
$25.44
|
| Rate for Payer: Cigna of CA HMO |
$20.35
|
| Rate for Payer: Cigna of CA PPO |
$23.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.67
|
| Rate for Payer: Galaxy Health WC |
$27.03
|
| Rate for Payer: Global Benefits Group Commercial |
$19.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| Rate for Payer: Networks By Design Commercial |
$20.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.70
|
| Rate for Payer: Prime Health Services Commercial |
$27.03
|
| Rate for Payer: Prime Health Services Medicare |
$10.28
|
| Rate for Payer: Riverside University Health System MISP |
$10.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.08
|
| 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: Upland Medical Group Pediatric |
$9.70
|
| 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
|
$31.80
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.62 |
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Central Health Plan Commercial |
$25.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Senior |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.03
|
| Rate for Payer: Global Benefits Group Commercial |
$19.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| Rate for Payer: Networks By Design Commercial |
$20.67
|
| Rate for Payer: Prime Health Services Commercial |
$27.03
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Adventist Health Commercial |
$4.91
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Central Health Plan Commercial |
$19.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.83
|
| Rate for Payer: EPIC Health Plan Senior |
$9.83
|
| Rate for Payer: Galaxy Health WC |
$20.88
|
| Rate for Payer: Global Benefits Group Commercial |
$14.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$18.43
|
| Rate for Payer: Networks By Design Commercial |
$15.97
|
| Rate for Payer: Prime Health Services Commercial |
$20.88
|
|
