|
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
|
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 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 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 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 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
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.89
|
| Rate for Payer: Blue Shield of California Commercial |
$41.48
|
| Rate for Payer: Blue Shield of California EPN |
$27.40
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.06
|
| Rate for Payer: EPIC Health Plan Senior |
$16.34
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.90
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.34
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$37.77 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.77
|
| Rate for Payer: Blue Shield of California Commercial |
$29.44
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.17
|
| Rate for Payer: EPIC Health Plan Senior |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.27
|
| Rate for Payer: EPIC Health Plan Senior |
$9.09
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.18
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SBBB PHONE ORDER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$15.35
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| 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 PHONE ORDER
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| 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 |
$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 |
$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 |
$280.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.67
|
| Rate for Payer: EPIC Health Plan Senior |
$187.16
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.79
|
| 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 |
$187.16
|
| 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 |
$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 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 |
$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 PLASMA FROZEN
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
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 PLATELET ANTIBODY SCREEN
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$283.05 |
| 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 |
$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 |
$153.94
|
| 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 |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| 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 |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| 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 |
$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 PLATELET APHERESIS CROSSM
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.22
|
| 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 |
$272.66
|
| 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 |
$284.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| 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 |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| 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 |
$355.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| 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 |
$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 PLATELET APHERESIS CROSSM
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$491.30 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Senior |
$231.20
|
| Rate for Payer: Galaxy Health WC |
$491.30
|
| Rate for Payer: Global Benefits Group Commercial |
$346.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$385.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.72
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: Networks By Design Commercial |
$375.70
|
| Rate for Payer: Prime Health Services Commercial |
$491.30
|
|
