|
HC SOM GANGLIOSIDE AB IGG ASIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| 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 IGG ASIALO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911440
|
|
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 |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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 IGG DISIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912816
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| 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 IGG DISIALO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912816
|
|
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 |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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 IGG MONO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Medicare Advantage |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| 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 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 |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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 |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| 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 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 |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| 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 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 |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$12.88
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$222.13 |
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| 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 GASTRIN
|
Facility
|
IP
|
$17.42
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.22
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.79
|
| Rate for Payer: Heritage Provider Network Senior |
$11.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$13.06
|
|
|
HC SOM GASTRIN
|
Facility
|
OP
|
$17.42
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$167.48 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| 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 HMO/PPO |
$167.48
|
| Rate for Payer: Blue Shield of California Commercial |
$141.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.84
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.32
|
| 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: EPIC Health Plan Commercial |
$10.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.78
|
| Rate for Payer: Heritage Provider Network Senior |
$10.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.62
|
| Rate for Payer: Multiplan Commercial |
$13.06
|
| 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 |
$26.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Vantage Medical Group Senior |
$17.63
|
|
|
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 |
$237.46
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.63
|
| Rate for Payer: Heritage Provider Network Senior |
$249.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.18
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
|
|
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 |
$2,442.78 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.88
|
| 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 HMO/PPO |
$2,442.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,661.77
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Cash Price |
$368.73
|
| 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 |
$283.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$175.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.98
|
| 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 |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
IP
|
$27.10
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$20.32 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.45
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.35
|
| Rate for Payer: Heritage Provider Network Senior |
$18.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$20.32
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
OP
|
$27.10
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$88.53 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.53
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.77
|
| Rate for Payer: Heritage Provider Network Senior |
$16.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$20.32
|
| 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 GLIADIN(DEAMIDATED) AB, IGA
|
Facility
|
IP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915374
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.34
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.13
|
| Rate for Payer: Heritage Provider Network Senior |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
|
|
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 |
$4.31 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.72
|
| 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 HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.48
|
| 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: EPIC Health Plan Commercial |
$14.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.74
|
| Rate for Payer: Heritage Provider Network Senior |
$14.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| 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 |
$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, IGG
|
Facility
|
OP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.72
|
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| 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 HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.48
|
| 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: EPIC Health Plan Commercial |
$14.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.74
|
| Rate for Payer: Heritage Provider Network Senior |
$14.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| 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 |
$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, IGG
|
Facility
|
IP
|
$23.82
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900915373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.34
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.13
|
| Rate for Payer: Heritage Provider Network Senior |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$17.86
|
|
|
HC SOM GLUCAGON
|
Facility
|
IP
|
$45.20
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$33.90 |
| Rate for Payer: Adventist Health Commercial |
$9.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.11
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Senior |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Multiplan Commercial |
$33.90
|
|
|
HC SOM GLUCAGON
|
Facility
|
OP
|
$45.20
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$115.19 |
| Rate for Payer: Adventist Health Commercial |
$9.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.93
|
| 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 HMO/PPO |
$115.19
|
| Rate for Payer: Blue Shield of California Commercial |
$115.03
|
| Rate for Payer: Blue Shield of California EPN |
$92.26
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.38
|
| 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: EPIC Health Plan Commercial |
$26.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.98
|
| Rate for Payer: Heritage Provider Network Senior |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$33.90
|
| 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 |
$21.43
|
| 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 |
$5.76 |
| Max. Negotiated Rate |
$92.05 |
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.65
|
| 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 HMO/PPO |
$92.05
|
| Rate for Payer: Blue Shield of California Commercial |
$78.05
|
| Rate for Payer: Blue Shield of California EPN |
$62.60
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.67
|
| 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: EPIC Health Plan Commercial |
$18.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.68
|
| Rate for Payer: Heritage Provider Network Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| 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
|
|
