|
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 |
$1,333.80 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,185.60
|
| 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: Health Management Network EPO/PPO |
$1,333.80
|
| 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 |
$296.40
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| 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 |
$4,604.84 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$856.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,604.84
|
| 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 Exchange |
$717.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$862.08
|
| Rate for Payer: Blue Shield of California Commercial |
$939.59
|
| Rate for Payer: Blue Shield of California EPN |
$591.32
|
| 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: Central Health Plan Commercial |
$1,185.60
|
| 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: Health Management Network EPO/PPO |
$1,333.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,403.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,298.53
|
| 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 |
$296.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,147.16
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$856.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
| Rate for Payer: Prime Health Services Medicare |
$907.46
|
| Rate for Payer: Riverside University Health System MISP |
$941.70
|
| 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 |
$996.30 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$196.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$382.62
|
| 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 Exchange |
$536.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.94
|
| Rate for Payer: Blue Shield of California Commercial |
$701.84
|
| Rate for Payer: Blue Shield of California EPN |
$441.69
|
| 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: Central Health Plan Commercial |
$885.60
|
| 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: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$321.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.62
|
| 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 |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$196.19
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Prime Health Services Medicare |
$207.96
|
| Rate for Payer: Riverside University Health System MISP |
$215.81
|
| 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 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 COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$996.30 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Central Health Plan Commercial |
$885.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$996.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$653.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC SBBB CROSSMATCH PER UNIT
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904714
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC SBBB CROSSMATCH PER UNIT
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904714
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.16
|
| 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 Exchange |
$65.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| Rate for Payer: Blue Shield of California Commercial |
$86.22
|
| Rate for Payer: Blue Shield of California EPN |
$54.26
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| 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 |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| 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 |
$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 CRYOPRECIPITATE
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904563
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$275.60
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
|
|
HC SBBB CRYOPRECIPITATE
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904563
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$205.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.64
|
| Rate for Payer: Blue Shield of California Commercial |
$268.82
|
| Rate for Payer: Blue Shield of California EPN |
$169.18
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$271.36
|
| Rate for Payer: Cigna of CA PPO |
$313.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.46
|
| Rate for Payer: EPIC Health Plan Senior |
$99.64
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$275.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.58
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: Prime Health Services Medicare |
$96.01
|
| Rate for Payer: Riverside University Health System MISP |
$99.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.40
|
| 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 |
$90.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Vantage Medical Group Senior |
$90.58
|
|
|
HC SBBB CRYOPRECIPITATE FROM POOL OF 4
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904768
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.18
|
| Rate for Payer: Blue Shield of California Commercial |
$28.53
|
| Rate for Payer: Blue Shield of California EPN |
$17.95
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| 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 |
$135.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.46
|
| Rate for Payer: EPIC Health Plan Senior |
$99.64
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.58
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$96.01
|
| Rate for Payer: Riverside University Health System MISP |
$99.64
|
| 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 |
$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 |
$90.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Vantage Medical Group Senior |
$90.58
|
|
|
HC SBBB CRYOPRECIPITATE FROM POOL OF 4
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904768
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| 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: Health Management Network EPO/PPO |
$40.50
|
| 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 |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.64
|
| Rate for Payer: Blue Shield of California Commercial |
$74.81
|
| Rate for Payer: Blue Shield of California EPN |
$47.08
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.46
|
| Rate for Payer: EPIC Health Plan Senior |
$99.64
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.58
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Prime Health Services Medicare |
$96.01
|
| Rate for Payer: Riverside University Health System MISP |
$99.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| 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 |
$90.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Vantage Medical Group Senior |
$90.58
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Senior |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC SBBB DD ADMIN FEE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| 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 Exchange |
$75.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.75
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| 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: Health Management Network EPO/PPO |
$140.40
|
| 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 |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| 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 DD ADMIN FEE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| 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: Health Management Network EPO/PPO |
$140.40
|
| 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 |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$540.90 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Central Health Plan Commercial |
$480.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$240.40
|
| Rate for Payer: Galaxy Health WC |
$510.85
|
| Rate for Payer: Global Benefits Group Commercial |
$360.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$354.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.20
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: Networks By Design Commercial |
$390.65
|
| Rate for Payer: Prime Health Services Commercial |
$510.85
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$120.20 |
| Max. Negotiated Rate |
$827.71 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$333.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$827.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$500.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.60
|
| Rate for Payer: Blue Shield of California Commercial |
$381.03
|
| Rate for Payer: Blue Shield of California EPN |
$239.80
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Central Health Plan Commercial |
$480.80
|
| Rate for Payer: Cigna of CA HMO |
$384.64
|
| Rate for Payer: Cigna of CA PPO |
$444.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$500.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$333.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.85
|
| Rate for Payer: EPIC Health Plan Senior |
$367.24
|
| Rate for Payer: Galaxy Health WC |
$510.85
|
| Rate for Payer: Global Benefits Group Commercial |
$360.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$547.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$376.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$333.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$447.36
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: Networks By Design Commercial |
$390.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$333.85
|
| Rate for Payer: Prime Health Services Commercial |
$510.85
|
| Rate for Payer: Prime Health Services Medicare |
$353.88
|
| Rate for Payer: Riverside University Health System MISP |
$367.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.60
|
| 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 |
$333.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$500.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.24
|
| Rate for Payer: Vantage Medical Group Senior |
$333.85
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$616.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: EPIC Health Plan Senior |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$519.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.20
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$5,375.18 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$532.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,375.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.48
|
| Rate for Payer: Blue Shield of California Commercial |
$558.55
|
| Rate for Payer: Blue Shield of California EPN |
$351.52
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.80
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$532.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$616.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$878.00
|
| Rate for Payer: EPIC Health Plan Senior |
$585.33
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$872.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$532.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$744.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$713.04
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$532.12
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Prime Health Services Medicare |
$564.05
|
| Rate for Payer: Riverside University Health System MISP |
$585.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| 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 |
$532.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$798.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.33
|
| Rate for Payer: Vantage Medical Group Senior |
$532.12
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.00
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SBBB DILUTION
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$149.16 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.16
|
| 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 Exchange |
$104.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.64
|
| Rate for Payer: Blue Shield of California Commercial |
$22.05
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| 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 |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| 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 DILUTION
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SBBB ELUTION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Senior |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
|
|
HC SBBB ELUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$361.55 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.00
|
| 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 Exchange |
$196.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.04
|
| Rate for Payer: Blue Shield of California Commercial |
$51.03
|
| Rate for Payer: Blue Shield of California EPN |
$32.16
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$51.84
|
| Rate for Payer: Cigna of CA PPO |
$59.94
|
| 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 |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.60
|
| 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 FFP APHERESIS TO 499 ML
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$438.30 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.40
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
|
