|
HC SBBB PHONE ORDER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Blue Shield of California Commercial |
$15.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.20
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.81
|
| Rate for Payer: Blue Shield of California Commercial |
$310.49
|
| Rate for Payer: Blue Shield of California EPN |
$248.39
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.88
|
| Rate for Payer: Dignity Health Senior |
$187.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$187.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.82
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$205.88
|
| Rate for Payer: TriValley Medical Group Senior |
$187.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.88
|
| Rate for Payer: Vantage Medical Group Senior |
$187.16
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.81
|
| Rate for Payer: Blue Shield of California Commercial |
$310.49
|
| Rate for Payer: Blue Shield of California EPN |
$248.39
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.36
|
| Rate for Payer: Dignity Health Senior |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.82
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.36
|
| Rate for Payer: TriValley Medical Group Senior |
$90.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Vantage Medical Group Senior |
$90.33
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$249.75 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.29
|
| Rate for Payer: Blue Shield of California Commercial |
$147.80
|
| Rate for Payer: Blue Shield of California EPN |
$118.55
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$216.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.13
|
| Rate for Payer: Heritage Provider Network Senior |
$206.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.15
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$249.75 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.44
|
| Rate for Payer: Heritage Provider Network Senior |
$225.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.59
|
| Rate for Payer: Heritage Provider Network Senior |
$300.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$237.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$305.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.93
|
| Rate for Payer: Blue Shield of California Commercial |
$270.84
|
| Rate for Payer: Blue Shield of California EPN |
$216.67
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.84
|
| Rate for Payer: Heritage Provider Network Senior |
$274.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$211.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$239.50
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.62 |
| Max. Negotiated Rate |
$928.37 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$308.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.96
|
| Rate for Payer: Blue Shield of California Commercial |
$352.58
|
| Rate for Payer: Blue Shield of California EPN |
$282.06
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Senior |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$618.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.78
|
| Rate for Payer: Heritage Provider Network Senior |
$357.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$809.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$779.83
|
| Rate for Payer: Multiplan Commercial |
$433.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$680.80
|
| Rate for Payer: TriValley Medical Group Senior |
$618.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.62 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.31
|
| Rate for Payer: Heritage Provider Network Senior |
$391.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.50
|
| Rate for Payer: Multiplan Commercial |
$433.50
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$928.37 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.87
|
| Rate for Payer: Blue Shield of California Commercial |
$387.96
|
| Rate for Payer: Blue Shield of California EPN |
$310.37
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$413.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Senior |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$618.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.68
|
| Rate for Payer: Heritage Provider Network Senior |
$393.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$809.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$779.83
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$680.80
|
| Rate for Payer: TriValley Medical Group Senior |
$618.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.57
|
| Rate for Payer: Heritage Provider Network Senior |
$430.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$443.25 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.11
|
| Rate for Payer: Heritage Provider Network Senior |
$400.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$928.37 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$315.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.33
|
| Rate for Payer: Blue Shield of California Commercial |
$360.51
|
| Rate for Payer: Blue Shield of California EPN |
$288.41
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Senior |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$618.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.83
|
| Rate for Payer: Heritage Provider Network Senior |
$365.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$809.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$281.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$779.83
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$680.80
|
| Rate for Payer: TriValley Medical Group Senior |
$618.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$746.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$443.71
|
| Rate for Payer: Blue Shield of California Commercial |
$477.02
|
| Rate for Payer: Blue Shield of California EPN |
$381.62
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.82
|
| Rate for Payer: Dignity Health Senior |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$746.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.06
|
| Rate for Payer: Heritage Provider Network Senior |
$484.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,011.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$746.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$373.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$858.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$940.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$940.21
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$820.82
|
| Rate for Payer: TriValley Medical Group Senior |
$746.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Vantage Medical Group Senior |
$746.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.41
|
| Rate for Payer: Heritage Provider Network Senior |
$529.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$396.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$746.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.44
|
| Rate for Payer: Blue Shield of California Commercial |
$452.01
|
| Rate for Payer: Blue Shield of California EPN |
$361.61
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.82
|
| Rate for Payer: Dignity Health Senior |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$746.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.68
|
| Rate for Payer: Heritage Provider Network Senior |
$458.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,011.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$746.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$353.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$858.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$940.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$940.21
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$820.82
|
| Rate for Payer: TriValley Medical Group Senior |
$746.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Vantage Medical Group Senior |
$746.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.66
|
| Rate for Payer: Heritage Provider Network Senior |
$501.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.25
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$113.20 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California EPN |
$29.28
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.47
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$61.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| 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 SBBB POOLING OF COMPONENTS
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.82
|
| Rate for Payer: Blue Shield of California Commercial |
$70.76
|
| Rate for Payer: Blue Shield of California EPN |
$56.61
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$75.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.80
|
| Rate for Payer: Heritage Provider Network Senior |
$71.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$239.50
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB POOLING OF COMPONENTS
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC SBBB PRE TREAT PANEL W ENZYMES
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.47
|
| Rate for Payer: Blue Shield of California Commercial |
$76.75
|
| Rate for Payer: Blue Shield of California EPN |
$61.72
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.71
|
| Rate for Payer: Heritage Provider Network Senior |
$68.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB PRE TREAT PANEL W ENZYMES
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.15
|
| Rate for Payer: Heritage Provider Network Senior |
$75.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
|
