|
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
|
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 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 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 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 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
|
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 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 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
|
|
|
HC SBBB RBC OCTOPED CMV LEUKOREDU
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904705
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$139.40 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Senior |
$65.60
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.36
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
|
|
HC SBBB RBC OCTOPED CMV LEUKOREDU
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904705
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.57
|
| 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 |
$100.71
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna of CA HMO |
$104.96
|
| Rate for Payer: Cigna of CA PPO |
$121.36
|
| 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 |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| 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 |
$109.39
|
| 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 |
$39.36
|
| 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 |
$131.20
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.40
|
| 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 RETIC SEPARATION
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
900904737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| 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 |
$177.75
|
| Rate for Payer: Blue Shield of California Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.13
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| 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 |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| 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 |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB RETIC SEPARATION
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
900904737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC SBBB RH DISCREP ADD'L TEST
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900905005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC SBBB RH DISCREP ADD'L TEST
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900905005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$57.53
|
| Rate for Payer: Blue Shield of California EPN |
$38.01
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC SBBB RH D TYPING
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC SBBB RH D TYPING
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SBBB RH PHENOTYPING
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
900904623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
