|
HC SBBB FFP TO 399 ML
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.85
|
| 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 |
$312.58
|
| 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 |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.95
|
| Rate for Payer: EPIC Health Plan Senior |
$90.33
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.04
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.33
|
| 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 FFP TO 399 ML
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC SBBB FREEZE & DEGLYC PROC
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC SBBB FREEZE & DEGLYC PROC
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.37
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$4,373.25 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,374.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,829.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,858.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,159.54
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Cigna of CA HMO |
$3,292.80
|
| Rate for Payer: Cigna of CA PPO |
$3,807.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,373.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,373.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,331.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,636.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,234.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,601.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,344.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,087.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,087.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,373.25
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,373.25 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,960.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,234.80
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,344.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$54.66 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| 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 |
$54.66
|
| Rate for Payer: Blue Shield of California Commercial |
$28.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.01
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| 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
|
$43.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.94
|
| 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 |
$212.48
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna of CA HMO |
$221.44
|
| Rate for Payer: Cigna of CA PPO |
$256.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.30
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.00
|
| 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 HLA MATCHED PRODUCTS
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$294.10 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$138.40
|
| Rate for Payer: Galaxy Health WC |
$294.10
|
| Rate for Payer: Global Benefits Group Commercial |
$207.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.04
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Networks By Design Commercial |
$224.90
|
| Rate for Payer: Prime Health Services Commercial |
$294.10
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$831.51 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.24
|
| Rate for Payer: Blue Shield of California Commercial |
$222.78
|
| Rate for Payer: Blue Shield of California EPN |
$147.19
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO |
$213.12
|
| Rate for Payer: Cigna of CA PPO |
$246.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.51
|
| Rate for Payer: United Healthcare All Other HMO |
$224.51
|
| Rate for Payer: United Healthcare HMO Rider |
$224.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$283.05 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Senior |
$44.40
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.80
|
| 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 |
$142.24
|
| Rate for Payer: Blue Shield of California Commercial |
$74.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.06
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna of CA HMO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$82.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| 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 IRRADIATION
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC SBBB IRRADIATION
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.48
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.08
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.93
|
| Rate for Payer: EPIC Health Plan Senior |
$62.17
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.31
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.39
|
| Rate for Payer: Vantage Medical Group Senior |
$62.17
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$140.20 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$280.40
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$140.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$314.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.48
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cigna of CA HMO |
$448.64
|
| Rate for Payer: Cigna of CA PPO |
$518.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.15
|
| Rate for Payer: EPIC Health Plan Senior |
$286.04
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$428.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$286.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$360.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$383.29
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$286.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.64
|
| Rate for Payer: Vantage Medical Group Senior |
$286.04
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.48
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cigna of CA HMO |
$448.64
|
| Rate for Payer: Cigna of CA PPO |
$518.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.38
|
| Rate for Payer: EPIC Health Plan Senior |
$106.95
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$247.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.31
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.64
|
| Rate for Payer: Vantage Medical Group Senior |
$106.95
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$140.20 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.40
|
| Rate for Payer: EPIC Health Plan Senior |
$280.40
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$472.60 |
| Rate for Payer: Adventist Health Commercial |
$111.20
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$222.40
|
| Rate for Payer: Galaxy Health WC |
$472.60
|
| Rate for Payer: Global Benefits Group Commercial |
$333.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$370.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$344.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.44
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Networks By Design Commercial |
$361.40
|
| Rate for Payer: Prime Health Services Commercial |
$472.60
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$1,478.16 |
| Rate for Payer: Adventist Health Commercial |
$111.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.68
|
| 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 |
$1,478.16
|
| Rate for Payer: Blue Shield of California Commercial |
$371.96
|
| Rate for Payer: Blue Shield of California EPN |
$245.75
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$355.84
|
| Rate for Payer: Cigna of CA PPO |
$411.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$472.60
|
| Rate for Payer: Global Benefits Group Commercial |
$333.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$370.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Networks By Design Commercial |
$361.40
|
| Rate for Payer: Prime Health Services Commercial |
$472.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| 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
|
$62.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
|
