|
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 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 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
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900905005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$73.10 |
| 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 |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| 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 |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| 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 |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| 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 |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
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 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 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 |
$62.24 |
| 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 |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| 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 |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| 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 |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| 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 |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
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
|
|
|
HC SBBB RH PHENOTYPING
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
900904623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$76.54 |
| 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 |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| 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 |
$11.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.38
|
| 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 |
$6.28
|
| Rate for Payer: United Healthcare All Other HMO |
$6.28
|
| Rate for Payer: United Healthcare HMO Rider |
$6.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.53
|
| Rate for Payer: Vantage Medical Group Senior |
$7.75
|
|
|
HC SBBB SEND OUT COORDINATION FEE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SBBB SEND OUT COORDINATION FEE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.70
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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 |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB SHIPPING OF BLOOD 1-6 UNI
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904609
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SBBB SHIPPING OF BLOOD 1-6 UNI
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904609
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.41
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SBBB STAT LABORATORY PROCEDURE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.09
|
| Rate for Payer: Blue Shield of California Commercial |
$70.91
|
| Rate for Payer: Blue Shield of California EPN |
$46.85
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB STAT LABORATORY PROCEDURE
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SBBB STAT SPECIMEN PICK UP/DEL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$96.89 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.89
|
| Rate for Payer: Blue Shield of California Commercial |
$50.84
|
| Rate for Payer: Blue Shield of California EPN |
$33.59
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SBBB STAT SPECIMEN PICK UP/DEL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC SBBB SUPER COOMBS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SBBB SUPER COOMBS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SBBB THERMAL AMPLITUDE STUDIES
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Senior |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.96
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC SBBB THERMAL AMPLITUDE STUDIES
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$300.90 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.66
|
| Rate for Payer: Blue Shield of California Commercial |
$236.83
|
| Rate for Payer: Blue Shield of California EPN |
$156.47
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna of CA HMO |
$226.56
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.88
|
| Rate for Payer: EPIC Health Plan Senior |
$8.06
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC SBBB TITRATION
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.55
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| 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 |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SBBB TITRATION
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
|
|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
