|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$507.60 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Central Health Plan Commercial |
$451.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Senior |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$2,006.74 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$644.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$310.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.45
|
| Rate for Payer: Blue Shield of California Commercial |
$407.03
|
| Rate for Payer: Blue Shield of California EPN |
$256.16
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Central Health Plan Commercial |
$513.60
|
| Rate for Payer: Cigna of CA HMO |
$410.88
|
| Rate for Payer: Cigna of CA PPO |
$475.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,062.67
|
| Rate for Payer: EPIC Health Plan Senior |
$708.44
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$577.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,056.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$644.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$901.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.01
|
| Rate for Payer: Multiplan Commercial |
$481.50
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$644.04
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
| Rate for Payer: Prime Health Services Medicare |
$682.68
|
| Rate for Payer: Riverside University Health System MISP |
$708.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.20
|
| 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 |
$644.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Vantage Medical Group Senior |
$644.04
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$577.80 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Central Health Plan Commercial |
$513.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$577.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Multiplan Commercial |
$481.50
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$2,006.74 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$644.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.37
|
| Rate for Payer: Blue Shield of California Commercial |
$375.33
|
| Rate for Payer: Blue Shield of California EPN |
$236.21
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Central Health Plan Commercial |
$473.60
|
| Rate for Payer: Cigna of CA HMO |
$378.88
|
| Rate for Payer: Cigna of CA PPO |
$438.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,062.67
|
| Rate for Payer: EPIC Health Plan Senior |
$708.44
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,056.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$644.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$901.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.01
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$644.04
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
| Rate for Payer: Prime Health Services Medicare |
$682.68
|
| Rate for Payer: Riverside University Health System MISP |
$708.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.20
|
| 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 |
$644.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Vantage Medical Group Senior |
$644.04
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Central Health Plan Commercial |
$473.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Senior |
$236.80
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.40
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$5,132.33 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$764.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,132.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$383.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.71
|
| Rate for Payer: Blue Shield of California Commercial |
$502.13
|
| Rate for Payer: Blue Shield of California EPN |
$316.01
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$841.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$764.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.74
|
| Rate for Payer: EPIC Health Plan Senior |
$841.16
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,254.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,074.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$764.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,070.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,024.68
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$764.69
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Prime Health Services Medicare |
$810.57
|
| Rate for Payer: Riverside University Health System MISP |
$841.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| 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 |
$764.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Vantage Medical Group Senior |
$764.69
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$667.80 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Central Health Plan Commercial |
$593.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$519.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.80
|
| Rate for Payer: EPIC Health Plan Senior |
$296.80
|
| Rate for Payer: Galaxy Health WC |
$630.70
|
| Rate for Payer: Global Benefits Group Commercial |
$445.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$667.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$471.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Networks By Design Commercial |
$482.30
|
| Rate for Payer: Prime Health Services Commercial |
$630.70
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$5,132.33 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$764.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,132.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$359.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.62
|
| Rate for Payer: Blue Shield of California Commercial |
$470.43
|
| Rate for Payer: Blue Shield of California EPN |
$296.06
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Central Health Plan Commercial |
$593.60
|
| Rate for Payer: Cigna of CA HMO |
$474.88
|
| Rate for Payer: Cigna of CA PPO |
$549.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$841.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$764.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$519.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.74
|
| Rate for Payer: EPIC Health Plan Senior |
$841.16
|
| Rate for Payer: Galaxy Health WC |
$630.70
|
| Rate for Payer: Global Benefits Group Commercial |
$445.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$667.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,254.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,074.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$764.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$471.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,070.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,024.68
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Networks By Design Commercial |
$482.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$764.69
|
| Rate for Payer: Prime Health Services Commercial |
$630.70
|
| Rate for Payer: Prime Health Services Medicare |
$810.57
|
| Rate for Payer: Riverside University Health System MISP |
$841.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$445.20
|
| 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 |
$764.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Vantage Medical Group Senior |
$764.69
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.12
|
| 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 |
$29.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.48
|
| Rate for Payer: Blue Shield of California Commercial |
$38.43
|
| Rate for Payer: Blue Shield of California EPN |
$24.22
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| 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 |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| 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 |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.05
|
| Rate for Payer: United Healthcare All Other HMO |
$46.05
|
| Rate for Payer: United Healthcare HMO Rider |
$46.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| 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 POOLING OF COMPONENTS
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC SBBB POOLING OF COMPONENTS
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.36
|
| 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 |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$76.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| 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 |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| 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 |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| 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 |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| 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 PRE TREAT PANEL W ENZYMES
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
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: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.46
|
| 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 |
$104.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.64
|
| Rate for Payer: Blue Shield of California Commercial |
$72.45
|
| Rate for Payer: Blue Shield of California EPN |
$45.66
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| 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: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.72
|
| 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 |
$32.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| 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 |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PRE TREAT PANEL W ENZYMES
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| 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: Health Management Network EPO/PPO |
$103.50
|
| 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 |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC SBBB PRE TREAT RBC CHEMICAL RE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$145.64 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.41
|
| 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 |
$104.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.64
|
| Rate for Payer: Blue Shield of California Commercial |
$72.45
|
| Rate for Payer: Blue Shield of California EPN |
$45.66
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| 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 |
$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 |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| 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 |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| 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 PRE TREAT RBC CHEMICAL RE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| 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: Health Management Network EPO/PPO |
$103.50
|
| 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 |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC SBBB RARE UNIT SEARCH
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904746
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SBBB RARE UNIT SEARCH
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904746
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.46
|
| 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 |
$96.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.34
|
| Rate for Payer: Blue Shield of California Commercial |
$126.80
|
| Rate for Payer: Blue Shield of California EPN |
$79.80
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| 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 |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| 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 |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| 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 |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| 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 |
$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 RBC FROZEN DEGLYCROLIZED
|
Facility
|
OP
|
$427.25
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
900904716
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$1,761.44 |
| Rate for Payer: Adventist Health Commercial |
$85.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,761.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$591.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.53
|
| Rate for Payer: Blue Shield of California Commercial |
$270.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.47
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Central Health Plan Commercial |
$341.80
|
| Rate for Payer: Cigna of CA HMO |
$273.44
|
| Rate for Payer: Cigna of CA PPO |
$316.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$591.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$299.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.17
|
| Rate for Payer: EPIC Health Plan Senior |
$433.44
|
| Rate for Payer: Galaxy Health WC |
$363.16
|
| Rate for Payer: Global Benefits Group Commercial |
$256.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$646.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$597.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$271.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$659.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$528.01
|
| Rate for Payer: Multiplan Commercial |
$320.44
|
| Rate for Payer: Networks By Design Commercial |
$277.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.04
|
| Rate for Payer: Prime Health Services Commercial |
$363.16
|
| Rate for Payer: Prime Health Services Medicare |
$417.68
|
| Rate for Payer: Riverside University Health System MISP |
$433.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$591.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.44
|
| Rate for Payer: Vantage Medical Group Senior |
$394.04
|
|
|
HC SBBB RBC FROZEN DEGLYCROLIZED
|
Facility
|
IP
|
$427.25
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
900904716
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.45 |
| Max. Negotiated Rate |
$384.52 |
| Rate for Payer: Adventist Health Commercial |
$85.45
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Central Health Plan Commercial |
$341.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$299.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.90
|
| Rate for Payer: EPIC Health Plan Senior |
$170.90
|
| Rate for Payer: Galaxy Health WC |
$363.16
|
| Rate for Payer: Global Benefits Group Commercial |
$256.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$271.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$252.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.45
|
| Rate for Payer: Multiplan Commercial |
$320.44
|
| Rate for Payer: Networks By Design Commercial |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$363.16
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Central Health Plan Commercial |
$272.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$136.00
|
| Rate for Payer: Galaxy Health WC |
$289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$306.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$255.00
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$289.00
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$1,302.92 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$232.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,302.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.78
|
| Rate for Payer: Blue Shield of California Commercial |
$215.56
|
| Rate for Payer: Blue Shield of California EPN |
$135.66
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Central Health Plan Commercial |
$272.00
|
| Rate for Payer: Cigna of CA HMO |
$217.60
|
| Rate for Payer: Cigna of CA PPO |
$251.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.09
|
| Rate for Payer: EPIC Health Plan Senior |
$256.06
|
| Rate for Payer: Galaxy Health WC |
$289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$306.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$381.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.93
|
| Rate for Payer: Multiplan Commercial |
$255.00
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$232.78
|
| Rate for Payer: Prime Health Services Commercial |
$289.00
|
| Rate for Payer: Prime Health Services Medicare |
$246.75
|
| Rate for Payer: Riverside University Health System MISP |
$256.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.00
|
| 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 |
$232.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Vantage Medical Group Senior |
$232.78
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: 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 |
$275.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$331.57
|
| Rate for Payer: Blue Shield of California Commercial |
$361.38
|
| Rate for Payer: Blue Shield of California EPN |
$227.43
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$364.80
|
| Rate for Payer: Cigna of CA PPO |
$421.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.71
|
| Rate for Payer: EPIC Health Plan Senior |
$215.81
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| 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 |
$361.95
|
| 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 |
$114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$196.19
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| 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 |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
|
