|
HC SBBB PHLEBOTOMY
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| 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 |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.27
|
| Rate for Payer: EPIC Health Plan Senior |
$9.09
|
| 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 |
$14.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: InnovAge PACE Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.18
|
| 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 |
$9.09
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$9.64
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| 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 |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC SBBB PHONE ORDER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| 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 |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| 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 |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| 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 |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| 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 |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| 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 |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PHONE ORDER
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$187.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.94
|
| Rate for Payer: Blue Shield of California Commercial |
$311.00
|
| Rate for Payer: Blue Shield of California EPN |
$203.09
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.67
|
| Rate for Payer: EPIC Health Plan Senior |
$187.16
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$306.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$187.16
|
| Rate for Payer: InnovAge PACE Commercial |
$280.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.79
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$187.16
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| Rate for Payer: Prime Health Services Medicare |
$198.39
|
| Rate for Payer: Riverside University Health System MISP |
$205.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| 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 |
$187.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.88
|
| Rate for Payer: Vantage Medical Group Senior |
$187.16
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.12
|
| 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 |
$246.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.94
|
| Rate for Payer: Blue Shield of California Commercial |
$311.00
|
| Rate for Payer: Blue Shield of California EPN |
$203.09
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: Cigna of CA HMO |
$325.76
|
| Rate for Payer: Cigna of CA PPO |
$376.66
|
| 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 |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.10
|
| 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 |
$339.50
|
| 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 |
$101.80
|
| 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 |
$381.75
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.33
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
| 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 |
$305.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.33
|
| 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 PLATELET ANTIBODY SCREEN
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.01
|
| Rate for Payer: Blue Shield of California Commercial |
$202.13
|
| Rate for Payer: Blue Shield of California EPN |
$132.20
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$213.12
|
| Rate for Payer: Cigna of CA PPO |
$246.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: InnovAge PACE Commercial |
$27.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.37
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
| Rate for Payer: Prime Health Services Medicare |
$19.47
|
| Rate for Payer: Riverside University Health System MISP |
$20.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Central Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.20
|
| Rate for Payer: EPIC Health Plan Senior |
$133.20
|
| Rate for Payer: Galaxy Health WC |
$283.05
|
| Rate for Payer: Global Benefits Group Commercial |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: Networks By Design Commercial |
$216.45
|
| Rate for Payer: Prime Health Services Commercial |
$283.05
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.64
|
| 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 |
$214.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.76
|
| Rate for Payer: Blue Shield of California Commercial |
$271.28
|
| Rate for Payer: Blue Shield of California EPN |
$177.16
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Central Health Plan Commercial |
$355.20
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$399.60
|
| 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 |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| 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 |
$333.00
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| 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 |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PLATELET APHERESIS CROSSM
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Central Health Plan Commercial |
$355.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$399.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$1,015.01 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$618.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$351.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$339.46
|
| Rate for Payer: Blue Shield of California Commercial |
$353.16
|
| Rate for Payer: Blue Shield of California EPN |
$230.62
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Central Health Plan Commercial |
$462.40
|
| Rate for Payer: Cigna of CA HMO |
$369.92
|
| Rate for Payer: Cigna of CA PPO |
$427.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.53
|
| Rate for Payer: EPIC Health Plan Senior |
$618.91
|
| Rate for Payer: Galaxy Health WC |
$491.30
|
| Rate for Payer: Global Benefits Group Commercial |
$346.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$520.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,015.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: InnovAge PACE Commercial |
$928.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$385.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$829.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.34
|
| Rate for Payer: Multiplan Commercial |
$433.50
|
| Rate for Payer: Networks By Design Commercial |
$375.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$618.91
|
| Rate for Payer: Prime Health Services Commercial |
$491.30
|
| Rate for Payer: Prime Health Services Medicare |
$656.04
|
| Rate for Payer: Riverside University Health System MISP |
$680.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.80
|
| 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 |
$618.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Central Health Plan Commercial |
$462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Senior |
$231.20
|
| Rate for Payer: Galaxy Health WC |
$491.30
|
| Rate for Payer: Global Benefits Group Commercial |
$346.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$520.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$385.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$357.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.60
|
| Rate for Payer: Multiplan Commercial |
$433.50
|
| Rate for Payer: Networks By Design Commercial |
$375.70
|
| Rate for Payer: Prime Health Services Commercial |
$491.30
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$572.40 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Central Health Plan Commercial |
$508.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$572.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$393.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$1,015.01 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$618.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$307.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.52
|
| Rate for Payer: Blue Shield of California Commercial |
$388.60
|
| Rate for Payer: Blue Shield of California EPN |
$253.76
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Central Health Plan Commercial |
$508.80
|
| Rate for Payer: Cigna of CA HMO |
$407.04
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.53
|
| Rate for Payer: EPIC Health Plan Senior |
$618.91
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$572.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,015.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: InnovAge PACE Commercial |
$928.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$829.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.34
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$618.91
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Prime Health Services Medicare |
$656.04
|
| Rate for Payer: Riverside University Health System MISP |
$680.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| 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 |
$618.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$1,015.01 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$618.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.09
|
| Rate for Payer: Blue Shield of California Commercial |
$361.10
|
| Rate for Payer: Blue Shield of California EPN |
$235.81
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: Cigna of CA HMO |
$378.24
|
| Rate for Payer: Cigna of CA PPO |
$437.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$618.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.53
|
| Rate for Payer: EPIC Health Plan Senior |
$618.91
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,015.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$618.91
|
| Rate for Payer: InnovAge PACE Commercial |
$928.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$618.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$829.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.34
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$618.91
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Prime Health Services Medicare |
$656.04
|
| Rate for Payer: Riverside University Health System MISP |
$680.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| 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 |
$618.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.80
|
| Rate for Payer: Vantage Medical Group Senior |
$618.91
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$531.90 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Central Health Plan Commercial |
$472.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$531.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.20
|
| Rate for Payer: Multiplan Commercial |
$443.25
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$1,223.77 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$746.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$746.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.27
|
| Rate for Payer: Blue Shield of California Commercial |
$477.80
|
| Rate for Payer: Blue Shield of California EPN |
$312.02
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.37
|
| Rate for Payer: EPIC Health Plan Senior |
$746.20
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,223.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,074.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$746.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,119.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$746.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$999.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.91
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Prime Health Services Medicare |
$790.97
|
| Rate for Payer: Riverside University Health System MISP |
$820.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| 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 |
$746.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Vantage Medical Group Senior |
$746.20
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$1,223.77 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$746.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$450.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$746.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$358.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$435.19
|
| Rate for Payer: Blue Shield of California Commercial |
$452.75
|
| Rate for Payer: Blue Shield of California EPN |
$295.66
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$820.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$746.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.37
|
| Rate for Payer: EPIC Health Plan Senior |
$746.20
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,223.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,074.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$746.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,119.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$746.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$999.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.91
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Prime Health Services Medicare |
$790.97
|
| Rate for Payer: Riverside University Health System MISP |
$820.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| 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 |
$746.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,119.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$820.82
|
| Rate for Payer: Vantage Medical Group Senior |
$746.20
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.44
|
| 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 |
$29.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.24
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| 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 |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| 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 |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| 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 |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| 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 |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| 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 |
$75.47
|
| 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 PLT PATHOGEN TESTING
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SBBB POOLING OF COMPONENTS
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC SBBB POOLING OF COMPONENTS
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.45
|
| 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 |
$56.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.13
|
| Rate for Payer: Blue Shield of California Commercial |
$70.88
|
| Rate for Payer: Blue Shield of California EPN |
$46.28
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| 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 |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| 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 |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| 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 |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| 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 |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| 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
|
|
