|
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: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$288.91
|
| Rate for Payer: 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
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 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: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$10.67
|
| Rate for Payer: 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 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: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$5.23
|
| Rate for Payer: 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
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: AlphaCare Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: AlphaCare 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: 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 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 PLASMA CRYO POOR
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$136.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.75
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$130.56
|
| Rate for Payer: 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
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
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 |
$125.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$142.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$104.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.16
|
| 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 |
$142.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.68
|
| Rate for Payer: Dignity Health Senior |
$95.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$95.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Humana Medicare |
$95.16
|
| Rate for Payer: IEHP Medi-Cal |
$121.57
|
| Rate for Payer: IEHP Medicare Advantage |
$95.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.90
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$104.68
|
| Rate for Payer: TriValley Medical Group Senior |
$95.16
|
| 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 |
$142.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.68
|
| Rate for Payer: Vantage Medical Group Senior |
$95.16
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.45
|
| Rate for Payer: Blue Shield of California Commercial |
$143.44
|
| Rate for Payer: Blue Shield of California EPN |
$112.13
|
| 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 |
$27.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: IEHP Medi-Cal |
$25.47
|
| Rate for Payer: IEHP Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| 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 |
$225.00
|
| 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 |
$27.56
|
| 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
|
$300.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
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 PLATELET APHERESIS CROSSM
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.80
|
| Rate for Payer: Heritage Provider Network Senior |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.40
|
| Rate for Payer: Blue Shield of California Commercial |
$248.40
|
| Rate for Payer: Blue Shield of California EPN |
$234.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| 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 |
$260.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| 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 |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$234.75
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| 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 |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.82
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.99
|
| Rate for Payer: Heritage Provider Network Senior |
$326.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
OP
|
$483.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$1,176.84 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$795.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$619.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.94
|
| Rate for Payer: Blue Shield of California EPN |
$283.52
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.33
|
| Rate for Payer: Dignity Health Senior |
$619.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$619.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.98
|
| Rate for Payer: Heritage Provider Network Senior |
$298.98
|
| Rate for Payer: Humana Medicare |
$619.39
|
| Rate for Payer: IEHP Medi-Cal |
$779.27
|
| Rate for Payer: IEHP Medicare Advantage |
$619.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,176.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$730.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$780.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$780.43
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$681.33
|
| Rate for Payer: TriValley Medical Group Senior |
$619.39
|
| 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 |
$929.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Vantage Medical Group Senior |
$619.39
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
OP
|
$509.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$1,176.84 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$795.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$619.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.91
|
| Rate for Payer: Blue Shield of California Commercial |
$316.09
|
| Rate for Payer: Blue Shield of California EPN |
$298.78
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.33
|
| Rate for Payer: Dignity Health Senior |
$619.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$619.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Humana Medicare |
$619.39
|
| Rate for Payer: IEHP Medi-Cal |
$779.27
|
| Rate for Payer: IEHP Medicare Advantage |
$619.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,176.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$730.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$780.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$780.43
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$681.33
|
| Rate for Payer: TriValley Medical Group Senior |
$619.39
|
| 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 |
$929.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Vantage Medical Group Senior |
$619.39
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
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: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Cash Price |
$229.05
|
| 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 PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
OP
|
$459.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$1,176.84 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$795.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$315.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$619.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.24
|
| Rate for Payer: Blue Shield of California Commercial |
$285.04
|
| Rate for Payer: Blue Shield of California EPN |
$269.43
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$298.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.33
|
| Rate for Payer: Dignity Health Senior |
$619.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$619.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.12
|
| Rate for Payer: Heritage Provider Network Senior |
$284.12
|
| Rate for Payer: Humana Medicare |
$619.39
|
| Rate for Payer: IEHP Medi-Cal |
$779.27
|
| Rate for Payer: IEHP Medicare Advantage |
$619.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,176.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$730.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$780.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$780.43
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$681.33
|
| Rate for Payer: TriValley Medical Group Senior |
$619.39
|
| 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 |
$929.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Vantage Medical Group Senior |
$619.39
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
IP
|
$459.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$315.33
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.74
|
| Rate for Payer: Heritage Provider Network Senior |
$310.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$2,034.55 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,034.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,084.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$722.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.48
|
| Rate for Payer: Blue Shield of California Commercial |
$401.17
|
| Rate for Payer: Blue Shield of California EPN |
$379.20
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.21
|
| Rate for Payer: Dignity Health Senior |
$722.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$722.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$399.87
|
| Rate for Payer: Humana Medicare |
$722.92
|
| Rate for Payer: IEHP Medi-Cal |
$974.47
|
| Rate for Payer: IEHP Medicare Advantage |
$722.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,373.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$910.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$910.88
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$795.21
|
| Rate for Payer: TriValley Medical Group Senior |
$722.92
|
| 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 |
$1,084.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: Vantage Medical Group Senior |
$722.92
|
|
|
HC SBBB PLATELETS APH/LEUOK PRT LOW YLD
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$2,034.55 |
| Rate for Payer: Adventist Health Commercial |
$119.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,034.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$409.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,084.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$722.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.81
|
| Rate for Payer: Blue Shield of California Commercial |
$370.12
|
| Rate for Payer: Blue Shield of California EPN |
$349.85
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$387.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.21
|
| Rate for Payer: Dignity Health Senior |
$722.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$722.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.92
|
| Rate for Payer: Heritage Provider Network Senior |
$368.92
|
| Rate for Payer: Humana Medicare |
$722.92
|
| Rate for Payer: IEHP Medi-Cal |
$974.47
|
| Rate for Payer: IEHP Medicare Advantage |
$722.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,373.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$910.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$910.88
|
| Rate for Payer: Multiplan Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$795.21
|
| Rate for Payer: TriValley Medical Group Senior |
$722.92
|
| 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 |
$1,084.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: Vantage Medical Group Senior |
$722.92
|
|
|
HC SBBB PLATELETS APH/LEUOK PRT LOW YLD
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$119.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$409.45
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$403.49
|
| Rate for Payer: Heritage Provider Network Senior |
$403.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$447.00
|
|
