|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$501.00 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Adventist Health Commercial |
$700.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,904.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,975.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,925.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,007.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,173.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,054.50
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,275.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,975.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,975.00
|
| Rate for Payer: Dignity Health Senior |
$2,975.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,275.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,166.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,166.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,164.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,687.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.00
|
| Rate for Payer: Multiplan Commercial |
$2,625.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,975.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,975.00
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$633.50 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Adventist Health Commercial |
$700.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.50
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,369.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,369.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.00
|
| Rate for Payer: Multiplan Commercial |
$2,625.00
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$46.32 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.32
|
| Rate for Payer: Blue Shield of California Commercial |
$43.10
|
| Rate for Payer: Blue Shield of California EPN |
$33.69
|
| 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 |
$8.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Senior |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.51
|
| Rate for Payer: TriValley Medical Group Senior |
$5.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Senior |
$26.40
|
| 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
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.93
|
| Rate for Payer: Blue Shield of California Commercial |
$193.75
|
| Rate for Payer: Blue Shield of California EPN |
$183.14
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$202.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Senior |
$58.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.13
|
| Rate for Payer: Heritage Provider Network Senior |
$193.13
|
| Rate for Payer: Humana Medicare |
$58.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.08
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$63.80
|
| Rate for Payer: TriValley Medical Group Senior |
$58.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$945.86 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.53
|
| Rate for Payer: Blue Shield of California Commercial |
$186.30
|
| Rate for Payer: Blue Shield of California EPN |
$176.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$945.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$497.82
|
| Rate for Payer: TriValley Medical Group Senior |
$497.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$299.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.53
|
| Rate for Payer: Blue Shield of California Commercial |
$62.10
|
| Rate for Payer: Blue Shield of California EPN |
$58.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SBBB IRRADIATION
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SBBB IRRADIATION
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.81
|
| Rate for Payer: Blue Shield of California Commercial |
$27.94
|
| Rate for Payer: Blue Shield of California EPN |
$26.42
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.57
|
| Rate for Payer: Blue Shield of California Commercial |
$385.02
|
| Rate for Payer: Blue Shield of California EPN |
$363.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$292.96
|
| Rate for Payer: Dignity Health Senior |
$266.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$383.78
|
| Rate for Payer: Humana Medicare |
$266.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$397.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.58
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$292.96
|
| Rate for Payer: TriValley Medical Group Senior |
$266.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$292.96
|
| Rate for Payer: Vantage Medical Group Senior |
$266.33
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$458.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.57
|
| Rate for Payer: Blue Shield of California Commercial |
$385.02
|
| Rate for Payer: Blue Shield of California EPN |
$363.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.69
|
| Rate for Payer: Dignity Health Senior |
$120.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$120.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$383.78
|
| Rate for Payer: Humana Medicare |
$120.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$229.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$120.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.99
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$132.69
|
| Rate for Payer: TriValley Medical Group Senior |
$120.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.69
|
| Rate for Payer: Vantage Medical Group Senior |
$120.63
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$338.50
|
| Rate for Payer: Heritage Provider Network Senior |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$1,252.63 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.63
|
| Rate for Payer: Blue Shield of California Commercial |
$310.50
|
| Rate for Payer: Blue Shield of California EPN |
$293.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Humana Medicare |
$185.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.57
|
| Rate for Payer: Blue Shield of California Commercial |
$74.24
|
| Rate for Payer: Blue Shield of California EPN |
$58.03
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.42
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.01
|
| Rate for Payer: Blue Shield of California Commercial |
$29.85
|
| Rate for Payer: Blue Shield of California EPN |
$23.34
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.92
|
| Rate for Payer: Blue Shield of California Commercial |
$16.77
|
| Rate for Payer: Blue Shield of California EPN |
$13.11
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.43
|
| Rate for Payer: Dignity Health Senior |
$8.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Humana Medicare |
$8.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.57
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$220.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.66
|
| Rate for Payer: Blue Shield of California Commercial |
$26.70
|
| Rate for Payer: Blue Shield of California EPN |
$25.24
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.75
|
| Rate for Payer: Dignity Health Senior |
$90.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Humana Medicare |
$90.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$172.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.26
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Senior |
$90.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.75
|
| Rate for Payer: Vantage Medical Group Senior |
$90.68
|
|
