|
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 |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
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 |
$3.62 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| 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 HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| 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 ASIALO
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
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 |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
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 |
$3.62 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| 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 HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| 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 |
$3.62 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| 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 HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| 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 |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM GASTRIN
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM GASTRIN
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$147.64 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| 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 HMO/PPO |
$147.64
|
| Rate for Payer: Blue Shield of California Commercial |
$137.74
|
| Rate for Payer: Blue Shield of California EPN |
$107.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.39
|
| Rate for Payer: Dignity Health Senior |
$17.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$17.63
|
| Rate for Payer: IEHP Medi-Cal |
$24.46
|
| Rate for Payer: IEHP Medicare Advantage |
$17.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.21
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.63
|
| Rate for Payer: TriValley Medical Group Senior |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.04
|
| 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 GHIVR 87901
|
Facility
OP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$2,153.45 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$749.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.32
|
| 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 HMO/PPO |
$2,153.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,010.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,571.85
|
| Rate for Payer: Cash Price |
$165.93
|
| Rate for Payer: Cash Price |
$165.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.20
|
| Rate for Payer: Dignity Health Senior |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$257.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.24
|
| Rate for Payer: Heritage Provider Network Senior |
$228.24
|
| Rate for Payer: Humana Medicare |
$257.45
|
| Rate for Payer: IEHP Medi-Cal |
$356.99
|
| Rate for Payer: IEHP Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$489.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.39
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$257.45
|
| Rate for Payer: TriValley Medical Group Senior |
$257.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$278.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$278.05
|
| 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 GHIVR 87901
|
Facility
IP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$276.55 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.32
|
| Rate for Payer: Cash Price |
$165.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.63
|
| Rate for Payer: Heritage Provider Network Senior |
$249.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.18
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| 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 HMO/PPO |
$78.05
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$12.92
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| 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 GLUCAGON
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$111.63 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| 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 HMO/PPO |
$101.54
|
| Rate for Payer: Blue Shield of California Commercial |
$111.63
|
| Rate for Payer: Blue Shield of California EPN |
$87.27
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.72
|
| Rate for Payer: Dignity Health Senior |
$14.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Humana Medicare |
$14.29
|
| Rate for Payer: IEHP Medi-Cal |
$19.81
|
| Rate for Payer: IEHP Medicare Advantage |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.29
|
| Rate for Payer: TriValley Medical Group Senior |
$14.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.43
|
| 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 |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Senior |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
|
|
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 |
$4.10 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.55
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.33
|
| Rate for Payer: Heritage Provider Network Senior |
$15.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$16.98
|
|
|
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 |
$4.10 |
| Max. Negotiated Rate |
$81.15 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.55
|
| 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 HMO/PPO |
$81.15
|
| Rate for Payer: Blue Shield of California Commercial |
$75.74
|
| Rate for Payer: Blue Shield of California EPN |
$59.21
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Cash Price |
$10.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.67
|
| Rate for Payer: Dignity Health Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Senior |
$14.01
|
| Rate for Payer: Humana Medicare |
$9.70
|
| Rate for Payer: IEHP Medi-Cal |
$13.45
|
| Rate for Payer: IEHP Medicare Advantage |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$16.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.70
|
| Rate for Payer: TriValley Medical Group Senior |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.48
|
| 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 GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
IP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.96
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.69
|
| Rate for Payer: Heritage Provider Network Senior |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
|
|
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 |
$5.00 |
| Max. Negotiated Rate |
$129.80 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.96
|
| 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 HMO/PPO |
$128.71
|
| Rate for Payer: Blue Shield of California Commercial |
$129.80
|
| Rate for Payer: Blue Shield of California EPN |
$101.47
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.08
|
| Rate for Payer: Heritage Provider Network Senior |
$17.08
|
| Rate for Payer: Humana Medicare |
$23.57
|
| Rate for Payer: IEHP Medi-Cal |
$28.22
|
| Rate for Payer: IEHP Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| 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 |
$2.28 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.66
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.53
|
| Rate for Payer: Heritage Provider Network Senior |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
|
|
HC SOM GROWTH HORMONE
|
Facility
OP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$139.47 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.66
|
| 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 HMO/PPO |
$139.47
|
| Rate for Payer: Blue Shield of California Commercial |
$130.19
|
| Rate for Payer: Blue Shield of California EPN |
$101.78
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.34
|
| Rate for Payer: Dignity Health Senior |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7.80
|
| Rate for Payer: Humana Medicare |
$16.67
|
| Rate for Payer: IEHP Medi-Cal |
$23.12
|
| Rate for Payer: IEHP Medicare Advantage |
$16.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.67
|
| Rate for Payer: TriValley Medical Group Senior |
$16.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.00
|
| 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 |
$10.86 |
| Max. Negotiated Rate |
$121.77 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| 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 HMO/PPO |
$121.77
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$88.89
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.36
|
| Rate for Payer: Dignity Health Senior |
$15.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Humana Medicare |
$15.78
|
| Rate for Payer: IEHP Medi-Cal |
$20.20
|
| Rate for Payer: IEHP Medicare Advantage |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.88
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.78
|
| Rate for Payer: TriValley Medical Group Senior |
$15.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.04
|
| 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 |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM HANDLING FEE
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$82.10 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.10
|
| Rate for Payer: Blue Shield of California Commercial |
$24.22
|
| Rate for Payer: Blue Shield of California EPN |
$22.89
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Senior |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC SOM HANDLING FEE
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
