|
HC SBBB COOMBS DIRECT EA ANTISERA
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SBBB COOMBS DIRECT EA ANTISERA
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$39.08 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SBBB CROSSMATCH PER UNIT
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904714
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.94
|
| Rate for Payer: Blue Shield of California Commercial |
$80.04
|
| Rate for Payer: Blue Shield of California EPN |
$52.27
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$83.84
|
| Rate for Payer: Cigna of CA PPO |
$96.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| 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 |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB CROSSMATCH PER UNIT
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904714
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
|
|
HC SBBB CRYOPRECIPITATE
|
Facility
|
OP
|
$489.00
|
|
|
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 |
$97.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$80.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$296.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.19
|
| Rate for Payer: Blue Shield of California Commercial |
$298.78
|
| Rate for Payer: Blue Shield of California EPN |
$195.11
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Central Health Plan Commercial |
$391.20
|
| Rate for Payer: Cigna of CA HMO |
$312.96
|
| Rate for Payer: Cigna of CA PPO |
$361.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.04
|
| Rate for Payer: EPIC Health Plan Senior |
$80.77
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$440.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$132.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.77
|
| Rate for Payer: InnovAge PACE Commercial |
$121.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.23
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: Networks By Design Commercial |
$317.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80.77
|
| Rate for Payer: Prime Health Services Commercial |
$415.65
|
| Rate for Payer: Prime Health Services Medicare |
$85.62
|
| Rate for Payer: Riverside University Health System MISP |
$88.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$293.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$293.40
|
| 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 |
$80.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Vantage Medical Group Senior |
$80.77
|
|
|
HC SBBB CRYOPRECIPITATE
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904563
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$440.10 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Central Health Plan Commercial |
$391.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$195.60
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$440.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.80
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: Networks By Design Commercial |
$317.85
|
| Rate for Payer: Prime Health Services Commercial |
$415.65
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| 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 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 |
$80.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.43
|
| Rate for Payer: Blue Shield of California Commercial |
$27.50
|
| 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 |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.04
|
| Rate for Payer: EPIC Health Plan Senior |
$80.77
|
| 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 |
$132.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.77
|
| Rate for Payer: InnovAge PACE Commercial |
$121.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.23
|
| 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 |
$80.77
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$85.62
|
| Rate for Payer: Riverside University Health System MISP |
$88.85
|
| 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 |
$80.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Vantage Medical Group Senior |
$80.77
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$80.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.35
|
| Rate for Payer: Blue Shield of California Commercial |
$79.43
|
| Rate for Payer: Blue Shield of California EPN |
$51.87
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.04
|
| Rate for Payer: EPIC Health Plan Senior |
$80.77
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$132.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.77
|
| Rate for Payer: InnovAge PACE Commercial |
$121.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.23
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$80.77
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Medicare |
$85.62
|
| Rate for Payer: Riverside University Health System MISP |
$88.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| 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 |
$80.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Vantage Medical Group Senior |
$80.77
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC SBBB DD ADMIN FEE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC SBBB DD ADMIN FEE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$92.26
|
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$308.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$363.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.21
|
| Rate for Payer: Blue Shield of California Commercial |
$365.38
|
| Rate for Payer: Blue Shield of California EPN |
$238.60
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$308.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.85
|
| Rate for Payer: EPIC Health Plan Senior |
$308.04
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$505.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$376.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.04
|
| Rate for Payer: InnovAge PACE Commercial |
$462.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$412.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$412.77
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$308.04
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Medicare |
$326.52
|
| Rate for Payer: Riverside University Health System MISP |
$338.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.80
|
| 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 |
$308.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.84
|
| Rate for Payer: Vantage Medical Group Senior |
$308.04
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$1,011.40 |
| Rate for Payer: Adventist Health Commercial |
$185.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$616.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$562.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$616.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$544.43
|
| Rate for Payer: Blue Shield of California Commercial |
$566.40
|
| Rate for Payer: Blue Shield of California EPN |
$369.87
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Central Health Plan Commercial |
$741.60
|
| Rate for Payer: Cigna of CA HMO |
$593.28
|
| Rate for Payer: Cigna of CA PPO |
$685.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$678.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$616.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$832.56
|
| Rate for Payer: EPIC Health Plan Senior |
$616.71
|
| Rate for Payer: Galaxy Health WC |
$787.95
|
| Rate for Payer: Global Benefits Group Commercial |
$556.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$834.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,011.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$616.71
|
| Rate for Payer: InnovAge PACE Commercial |
$925.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$618.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$826.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$826.39
|
| Rate for Payer: Multiplan Commercial |
$695.25
|
| Rate for Payer: Networks By Design Commercial |
$602.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$616.71
|
| Rate for Payer: Prime Health Services Commercial |
$787.95
|
| Rate for Payer: Prime Health Services Medicare |
$653.71
|
| Rate for Payer: Riverside University Health System MISP |
$678.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$556.20
|
| 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 |
$616.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$678.38
|
| Rate for Payer: Vantage Medical Group Senior |
$616.71
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$834.30 |
| Rate for Payer: Adventist Health Commercial |
$185.40
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Central Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$370.80
|
| Rate for Payer: Galaxy Health WC |
$787.95
|
| Rate for Payer: Global Benefits Group Commercial |
$556.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$834.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$618.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.40
|
| Rate for Payer: Multiplan Commercial |
$695.25
|
| Rate for Payer: Networks By Design Commercial |
$602.55
|
| Rate for Payer: Prime Health Services Commercial |
$787.95
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$130.92 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.57
|
| Rate for Payer: Blue Shield of California Commercial |
$64.95
|
| Rate for Payer: Blue Shield of California EPN |
$42.48
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| 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 |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB DILUTION
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
|
|
HC SBBB DILUTION
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.26
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB ELUTION
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Blue Shield of California Commercial |
$47.35
|
| Rate for Payer: Blue Shield of California EPN |
$30.97
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB ELUTION
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC SBBB FFP APHERESIS TO 499 ML
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.01
|
| Rate for Payer: Blue Shield of California Commercial |
$336.05
|
| Rate for Payer: Blue Shield of California EPN |
$219.45
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$352.00
|
| Rate for Payer: Cigna of CA PPO |
$407.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.95
|
| Rate for Payer: EPIC Health Plan Senior |
$90.33
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$134.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.33
|
| Rate for Payer: InnovAge PACE Commercial |
$135.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.04
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.33
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Prime Health Services Medicare |
$95.75
|
| Rate for Payer: Riverside University Health System MISP |
$99.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| 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 |
$90.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Vantage Medical Group Senior |
$90.33
|
|
|
HC SBBB FFP APHERESIS TO 499 ML
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$340.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
|
|
HC SBBB FFP PEDS
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$180.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.02
|
| Rate for Payer: Blue Shield of California Commercial |
$297.56
|
| Rate for Payer: Blue Shield of California EPN |
$194.31
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Cigna of CA HMO |
$311.68
|
| Rate for Payer: Cigna of CA PPO |
$360.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| 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: Heritage Provider Network Commercial/Senior |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: InnovAge PACE Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$241.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$180.17
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: Prime Health Services Medicare |
$190.98
|
| Rate for Payer: Riverside University Health System MISP |
$198.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.20
|
| 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 |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
