|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,015.01 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$379.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.95
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cigna of CA HMO |
$369.92
|
| Rate for Payer: Cigna of CA PPO |
$427.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.53
|
| Rate for Payer: EPIC Health Plan Senior |
$618.91
|
| Rate for Payer: Galaxy Health WC |
$491.30
|
| Rate for Payer: Global Benefits Group Commercial |
$346.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$839.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$385.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.34
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.80
|
| 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 |
$618.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$1,015.01 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$417.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.57
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cigna of CA HMO |
$407.04
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.53
|
| Rate for Payer: EPIC Health Plan Senior |
$618.91
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$839.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.34
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| 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 |
$618.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$393.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$1,015.01 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.93
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna of CA HMO |
$378.24
|
| Rate for Payer: Cigna of CA PPO |
$437.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.53
|
| Rate for Payer: EPIC Health Plan Senior |
$618.91
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$839.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$779.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.34
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| 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 |
$618.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$664.70 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$1,223.77 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$746.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$480.23
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.37
|
| Rate for Payer: EPIC Health Plan Senior |
$746.20
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,223.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,049.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$746.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$746.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$940.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.91
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| 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 |
$746.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Vantage Medical Group Senior |
$746.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$1,223.77 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$746.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.05
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.37
|
| Rate for Payer: EPIC Health Plan Senior |
$746.20
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,223.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,049.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$746.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$746.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$940.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.91
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| 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 |
$746.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Vantage Medical Group Senior |
$746.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.85
|
| Rate for Payer: Blue Shield of California Commercial |
$40.14
|
| Rate for Payer: Blue Shield of California EPN |
$26.52
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.05
|
| Rate for Payer: United Healthcare All Other HMO |
$46.05
|
| Rate for Payer: United Healthcare HMO Rider |
$46.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB POOLING OF COMPONENTS
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.08
|
| 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 |
$71.24
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| 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 |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| 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 |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.84
|
| 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 |
$92.80
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| 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 |
$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 POOLING OF COMPONENTS
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$98.60 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.84
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC SBBB PRE TREAT PANEL W ENZYMES
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$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 PRE TREAT PANEL W ENZYMES
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
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 |
$29.03
|
| 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 |
$32.83
|
| 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 |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| 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 PRE TREAT RBC CHEMICAL RE
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
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 PRE TREAT RBC CHEMICAL RE
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$142.24 |
| 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 |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: 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 |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| 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 |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB RBC FROZEN DEGLYCROLIZED
|
Facility
|
OP
|
$427.25
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
900904716
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$1,362.25 |
| Rate for Payer: Adventist Health Commercial |
$85.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,245.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$913.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$830.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.37
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cigna of CA HMO |
$273.44
|
| Rate for Payer: Cigna of CA PPO |
$316.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,245.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$913.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$830.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,121.36
|
| Rate for Payer: EPIC Health Plan Senior |
$830.64
|
| Rate for Payer: Galaxy Health WC |
$363.16
|
| Rate for Payer: Global Benefits Group Commercial |
$256.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,362.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$583.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$830.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$830.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,113.06
|
| Rate for Payer: Multiplan Commercial |
$341.80
|
| Rate for Payer: Networks By Design Commercial |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$363.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.35
|
| 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 |
$830.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,245.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$913.70
|
| Rate for Payer: Vantage Medical Group Senior |
$830.64
|
|
|
HC SBBB RBC FROZEN DEGLYCROLIZED
|
Facility
|
IP
|
$427.25
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
900904716
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$363.16 |
| Rate for Payer: Adventist Health Commercial |
$85.45
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.90
|
| Rate for Payer: EPIC Health Plan Senior |
$170.90
|
| Rate for Payer: Galaxy Health WC |
$363.16
|
| Rate for Payer: Global Benefits Group Commercial |
$256.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.54
|
| Rate for Payer: Multiplan Commercial |
$341.80
|
| Rate for Payer: Networks By Design Commercial |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$363.16
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.86
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$254.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.19
|
| Rate for Payer: EPIC Health Plan Senior |
$231.25
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$231.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.88
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| 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: Upland Medical Group Pediatric |
$231.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$254.38
|
| Rate for Payer: Vantage Medical Group Senior |
$231.25
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$373.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.04
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna of CA HMO |
$364.80
|
| Rate for Payer: Cigna of CA PPO |
$421.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| 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: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 WHOLE UNIT
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900909508
|
|
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 |
$346.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.25
|
| 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 |
$346.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$254.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.19
|
| Rate for Payer: EPIC Health Plan Senior |
$231.25
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$231.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.88
|
| 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 |
$231.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$254.38
|
| Rate for Payer: Vantage Medical Group Senior |
$231.25
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 WHOLE UNIT
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900909508
|
|
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
|
|
