|
HC SBBB FFP PEDS
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$358.70 |
| Rate for Payer: Adventist Health Commercial |
$84.40
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$295.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.80
|
| Rate for Payer: EPIC Health Plan Senior |
$168.80
|
| Rate for Payer: Galaxy Health WC |
$358.70
|
| Rate for Payer: Global Benefits Group Commercial |
$253.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$267.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.28
|
| Rate for Payer: Multiplan Commercial |
$337.60
|
| Rate for Payer: Networks By Design Commercial |
$274.30
|
| Rate for Payer: Prime Health Services Commercial |
$358.70
|
|
|
HC SBBB FFP PEDS
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$84.40
|
| 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 |
$270.80
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cigna of CA HMO |
$270.08
|
| Rate for Payer: Cigna of CA PPO |
$312.28
|
| 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 |
$295.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.71
|
| Rate for Payer: EPIC Health Plan Senior |
$215.81
|
| Rate for Payer: Galaxy Health WC |
$358.70
|
| Rate for Payer: Global Benefits Group Commercial |
$253.20
|
| 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 |
$267.97
|
| 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 |
$101.28
|
| 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 |
$337.60
|
| Rate for Payer: Networks By Design Commercial |
$274.30
|
| Rate for Payer: Prime Health Services Commercial |
$358.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.20
|
| 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 |
$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
|
|
|
HC SBBB FFP SPLIT UNIT GT 150 ML
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.19 |
| Max. Negotiated Rate |
$833.85 |
| Rate for Payer: Vantage Medical Group Senior |
$196.19
|
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| 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 |
$629.51
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna of CA HMO |
$627.84
|
| Rate for Payer: Cigna of CA PPO |
$725.94
|
| 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 |
$686.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.71
|
| Rate for Payer: EPIC Health Plan Senior |
$215.81
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| 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 |
$622.93
|
| 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 |
$235.44
|
| 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 |
$784.80
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$588.60
|
| 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 |
$196.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.81
|
|
|
HC SBBB FFP SPLIT UNIT GT 150 ML
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$833.85 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$686.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.40
|
| Rate for Payer: EPIC Health Plan Senior |
$392.40
|
| Rate for Payer: Galaxy Health WC |
$833.85
|
| Rate for Payer: Global Benefits Group Commercial |
$588.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$622.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$578.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.44
|
| Rate for Payer: Multiplan Commercial |
$784.80
|
| Rate for Payer: Networks By Design Commercial |
$637.65
|
| Rate for Payer: Prime Health Services Commercial |
$833.85
|
|
|
HC SBBB FFP TO 399 ML
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$261.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
|
|
HC SBBB FFP TO 399 ML
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$284.91
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$310.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.24
|
| Rate for Payer: EPIC Health Plan Senior |
$102.16
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| 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 |
$281.94
|
| 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 |
$106.56
|
| 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 |
$355.20
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 FREEZE & DEGLYC PROC
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$221.85 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$104.40
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.64
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
|
|
HC SBBB FREEZE & DEGLYC PROC
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$480.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.28
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$167.04
|
| Rate for Payer: Cigna of CA PPO |
$193.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.60
|
| 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 |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
OP
|
$5,307.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$8,300.93 |
| Rate for Payer: Networks By Design Commercial |
$3,449.55
|
| Rate for Payer: Adventist Health Commercial |
$1,061.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,300.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,510.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,918.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,980.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,405.50
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Cigna of CA HMO |
$3,396.48
|
| Rate for Payer: Cigna of CA PPO |
$3,927.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,510.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,510.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,510.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,714.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,122.80
|
| Rate for Payer: Galaxy Health WC |
$4,510.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,184.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,331.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,369.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,636.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,131.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,273.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,714.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,714.90
|
| Rate for Payer: Multiplan Commercial |
$4,245.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,510.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,184.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$4,510.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,510.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,510.95
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
IP
|
$5,307.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,061.40 |
| Max. Negotiated Rate |
$4,510.95 |
| Rate for Payer: Adventist Health Commercial |
$1,061.40
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,714.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,122.80
|
| Rate for Payer: Galaxy Health WC |
$4,510.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,184.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,369.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,131.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,273.68
|
| Rate for Payer: Multiplan Commercial |
$4,245.60
|
| Rate for Payer: Networks By Design Commercial |
$3,449.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,510.95
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.12
|
| Rate for Payer: Blue Shield of California Commercial |
$20.75
|
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Senior |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$250.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$232.70
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.85
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cigna of CA HMO |
$229.12
|
| Rate for Payer: Cigna of CA PPO |
$264.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$250.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.70
|
| Rate for Payer: EPIC Health Plan Senior |
$63.80
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$232.70
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| 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 |
$58.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$948.02 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.64
|
| Rate for Payer: Blue Shield of California Commercial |
$159.04
|
| Rate for Payer: Blue Shield of California Commercial |
$240.47
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$224.51
|
| Rate for Payer: United Healthcare All Other HMO |
$224.51
|
| Rate for Payer: United Healthcare HMO Rider |
$224.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$361.55 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.64
|
| 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 |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| 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 |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| 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 |
$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 |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
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 IRRADIATION
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| 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 IRRADIATION
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
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 |
$142.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| 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 |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| 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 |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.88
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.36
|
| Rate for Payer: EPIC Health Plan Senior |
$48.91
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.58
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| 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 |
$44.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.91
|
| Rate for Payer: Vantage Medical Group Senior |
$44.46
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.32
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of CA HMO |
$453.12
|
| Rate for Payer: Cigna of CA PPO |
$523.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$495.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.33
|
| Rate for Payer: EPIC Health Plan Senior |
$262.89
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$391.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$428.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$238.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$449.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$484.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$334.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$460.20
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$424.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$424.80
|
| 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 |
$238.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$358.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.89
|
| Rate for Payer: Vantage Medical Group Senior |
$238.99
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$601.80 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$495.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$283.20
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$449.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$417.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$460.20
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$601.80 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$495.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$283.20
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$449.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$417.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$460.20
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
|
