|
HC SBBB ANTIBODY ID PANEL (LISS)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.23
|
| Rate for Payer: Blue Shield of California Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$72.49
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| 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 |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC SBBB ANTIBODY ID PANEL (LISS)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC SBBB ANTIBODY ID PANEL (PEG)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904423
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC SBBB ANTIBODY ID PANEL (PEG)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904423
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.87
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| 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 |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC SBBB ANTIBODY SCREEN
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC SBBB ANTIBODY SCREEN
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$117.56 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.46
|
| Rate for Payer: Blue Shield of California Commercial |
$53.02
|
| Rate for Payer: Blue Shield of California Commercial |
$80.16
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.12
|
| Rate for Payer: EPIC Health Plan Senior |
$10.75
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
HC SBBB ANTI-CMV
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900904446
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.79
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| 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 |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SBBB ANTI-CMV
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900904446
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC SBBB ANTIGEN SCREENING CLASS I
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904574
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.06
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| 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 |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING CLASS I
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904574
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SBBB ANTIGEN SCREENING CLASS II
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904769
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC SBBB ANTIGEN SCREENING CLASS II
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904769
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.68
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$84.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| 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 |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING RARE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904770
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.75
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| 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 |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING RARE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904770
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC SBBB AUTO ADMIN FEE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC SBBB AUTO ADMIN FEE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.11
|
| Rate for Payer: Blue Shield of California Commercial |
$108.73
|
| Rate for Payer: Blue Shield of California Commercial |
$71.92
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| 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 |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC SBBB COLD AGGLUTININ SCREEN
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC SBBB COLD AGGLUTININ SCREEN
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.59
|
| Rate for Payer: Blue Shield of California Commercial |
$105.94
|
| Rate for Payer: Blue Shield of California Commercial |
$70.07
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.32
|
| Rate for Payer: EPIC Health Plan Senior |
$8.88
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| 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 |
$8.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
HC SBBB CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$1,152.60 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$870.15
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cigna of CA HMO |
$867.84
|
| Rate for Payer: Cigna of CA PPO |
$1,003.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$949.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.24
|
| Rate for Payer: EPIC Health Plan Senior |
$102.16
|
| Rate for Payer: Galaxy Health WC |
$1,152.60
|
| Rate for Payer: Global Benefits Group Commercial |
$813.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$152.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$861.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.45
|
| Rate for Payer: Multiplan Commercial |
$1,084.80
|
| Rate for Payer: Networks By Design Commercial |
$881.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,152.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$813.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$813.60
|
| 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 |
$92.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$139.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.16
|
| Rate for Payer: Vantage Medical Group Senior |
$92.87
|
|
|
HC SBBB CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$1,152.60 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$949.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.40
|
| Rate for Payer: EPIC Health Plan Senior |
$542.40
|
| Rate for Payer: Galaxy Health WC |
$1,152.60
|
| Rate for Payer: Global Benefits Group Commercial |
$813.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$861.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$800.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.44
|
| Rate for Payer: Multiplan Commercial |
$1,084.80
|
| Rate for Payer: Networks By Design Commercial |
$881.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,152.60
|
|
|
HC SBBB COOMBS DIRECT EA ANTISERA
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC SBBB COOMBS DIRECT EA ANTISERA
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.70
|
| 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 |
$55.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.03
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| 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 |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| 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 COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,482.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,037.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.80
|
| Rate for Payer: EPIC Health Plan Senior |
$592.80
|
| Rate for Payer: Galaxy Health WC |
$1,259.70
|
| Rate for Payer: Global Benefits Group Commercial |
$889.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$874.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.68
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
|
|
HC SBBB COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$5,217.63 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,217.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,284.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$941.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$856.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$910.10
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna of CA HMO |
$948.48
|
| Rate for Payer: Cigna of CA PPO |
$1,096.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,284.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$941.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$856.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,037.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,412.55
|
| Rate for Payer: EPIC Health Plan Senior |
$941.70
|
| Rate for Payer: Galaxy Health WC |
$1,259.70
|
| Rate for Payer: Global Benefits Group Commercial |
$889.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,403.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,268.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$856.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,434.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,198.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,078.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,147.16
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$889.20
|
| 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 |
$856.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,284.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$941.70
|
| Rate for Payer: Vantage Medical Group Senior |
$856.09
|
|
|
HC SBBB COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.19 |
| Max. Negotiated Rate |
$940.95 |
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$433.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.36
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.71
|
| Rate for Payer: EPIC Health Plan Senior |
$215.81
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$321.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.20
|
| 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 Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$196.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.81
|
| Rate for Payer: Vantage Medical Group Senior |
$196.19
|
|
