|
HC SBBB SEND OUT COORDINATION FEE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SBBB SHIPPING OF BLOOD 1-6 UNI
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904609
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SBBB SHIPPING OF BLOOD 1-6 UNI
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904609
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.73
|
| Rate for Payer: Blue Shield of California Commercial |
$61.10
|
| Rate for Payer: Blue Shield of California EPN |
$39.90
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: InnovAge PACE Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SBBB STAT LABORATORY PROCEDURE
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SBBB STAT LABORATORY PROCEDURE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.37
|
| 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 |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.25
|
| Rate for Payer: Blue Shield of California Commercial |
$64.34
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| 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 |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| 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 |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| 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 |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| 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 |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 STAT SPECIMEN PICK UP/DEL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.48
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SBBB STAT SPECIMEN PICK UP/DEL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC SBBB SUPER COOMBS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| 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 |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$24.28
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| 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 |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| 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 |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| 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 |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| 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 |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| 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 |
$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 SUPER COOMBS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SBBB THERMAL AMPLITUDE STUDIES
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Senior |
$141.60
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
|
|
HC SBBB THERMAL AMPLITUDE STUDIES
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$214.88
|
| Rate for Payer: Blue Shield of California EPN |
$140.54
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Central Health Plan Commercial |
$283.20
|
| Rate for Payer: Cigna of CA HMO |
$226.56
|
| Rate for Payer: Cigna of CA PPO |
$261.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.88
|
| Rate for Payer: EPIC Health Plan Senior |
$8.06
|
| Rate for Payer: Galaxy Health WC |
$300.90
|
| Rate for Payer: Global Benefits Group Commercial |
$212.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: InnovAge PACE Commercial |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: Networks By Design Commercial |
$230.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.06
|
| Rate for Payer: Prime Health Services Commercial |
$300.90
|
| Rate for Payer: Prime Health Services Medicare |
$8.54
|
| Rate for Payer: Riverside University Health System MISP |
$8.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC SBBB TITRATION
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.42
|
| 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 |
$80.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.08
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.63
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| 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 |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.26
|
| 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 |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.40
|
| 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 |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| 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 |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| 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 |
$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 TITRATION
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
|
|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.09
|
| 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 |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.65
|
| Rate for Payer: Blue Shield of California Commercial |
$74.05
|
| Rate for Payer: Blue Shield of California EPN |
$48.43
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| 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 |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| 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 |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| 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 |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| 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 |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| 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 VOLUME REDUCTION
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.37
|
| 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 |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.25
|
| Rate for Payer: Blue Shield of California Commercial |
$64.77
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| 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 |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| 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 |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| 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 |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| 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 |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| 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 VOLUME REDUCTION
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.35
|
| 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 |
$76.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.21
|
| Rate for Payer: Blue Shield of California Commercial |
$95.30
|
| Rate for Payer: Blue Shield of California EPN |
$62.33
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| 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 |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| 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 |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| 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 |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| 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 |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| 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 WASHING OF COMPONENTS
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
|
|
HC SBRT
|
Facility
|
IP
|
$12,657.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
904877373
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,531.40 |
| Max. Negotiated Rate |
$11,391.30 |
| Rate for Payer: Adventist Health Commercial |
$2,531.40
|
| Rate for Payer: Cash Price |
$6,961.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,125.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,062.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,062.80
|
| Rate for Payer: Galaxy Health WC |
$10,758.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,594.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,391.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,822.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,834.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,531.40
|
| Rate for Payer: Multiplan Commercial |
$9,492.75
|
| Rate for Payer: Networks By Design Commercial |
$8,227.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,758.45
|
|
|
HC SBRT
|
Facility
|
OP
|
$12,657.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
904877373
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$11,391.30 |
| Rate for Payer: Adventist Health Commercial |
$2,531.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,231.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,686.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,346.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,454.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,231.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,595.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,744.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7,682.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,024.83
|
| Rate for Payer: Cash Price |
$6,961.35
|
| Rate for Payer: Cash Price |
$6,961.35
|
| Rate for Payer: Cash Price |
$6,961.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,125.60
|
| Rate for Payer: Cigna of CA HMO |
$8,100.48
|
| Rate for Payer: Cigna of CA PPO |
$9,366.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,346.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,454.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,231.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,231.06
|
| Rate for Payer: Galaxy Health WC |
$10,758.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,594.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,391.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,658.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,647.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,231.06
|
| Rate for Payer: InnovAge PACE Commercial |
$3,346.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,820.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,231.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,531.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,989.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,989.62
|
| Rate for Payer: Multiplan Commercial |
$9,492.75
|
| Rate for Payer: Networks By Design Commercial |
$8,227.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,231.06
|
| Rate for Payer: Prime Health Services Commercial |
$10,758.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,364.92
|
| Rate for Payer: Riverside University Health System MISP |
$2,454.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,594.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,231.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,346.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,454.17
|
| Rate for Payer: Vantage Medical Group Senior |
$2,231.06
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$464.40 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Adventist Health Commercial |
$464.40
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Senior |
$928.80
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,089.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,437.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$1,741.50
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Adventist Health Commercial |
$464.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,410.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$286.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,363.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,409.45
|
| Rate for Payer: Blue Shield of California EPN |
$921.83
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,857.60
|
| Rate for Payer: Cigna of CA HMO |
$1,486.08
|
| Rate for Payer: Cigna of CA PPO |
$1,718.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,973.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,089.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,741.50
|
| Rate for Payer: Networks By Design Commercial |
$1,509.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,973.70
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCAPULA
|
Facility
|
OP
|
$1,202.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$1,081.80 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$729.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$729.61
|
| Rate for Payer: Blue Shield of California EPN |
$477.19
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Central Health Plan Commercial |
$961.60
|
| Rate for Payer: Cigna of CA HMO |
$769.28
|
| Rate for Payer: Cigna of CA PPO |
$889.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,021.70
|
| Rate for Payer: Global Benefits Group Commercial |
$721.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,081.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
| Rate for Payer: Networks By Design Commercial |
$781.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,021.70
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$721.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$721.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCAPULA
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.40 |
| Max. Negotiated Rate |
$1,081.80 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Central Health Plan Commercial |
$961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.80
|
| Rate for Payer: EPIC Health Plan Senior |
$480.80
|
| Rate for Payer: Galaxy Health WC |
$1,021.70
|
| Rate for Payer: Global Benefits Group Commercial |
$721.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,081.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.40
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
| Rate for Payer: Networks By Design Commercial |
$781.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,021.70
|
|
