|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$120.63 |
| Max. Negotiated Rate |
$1,157.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$120.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,157.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.30
|
| Rate for Payer: Blue Distinction Transplant |
$372.00
|
| Rate for Payer: Blue Shield of California Commercial |
$389.98
|
| Rate for Payer: Blue Shield of California EPN |
$303.18
|
| Rate for Payer: Caremore Medicare Advantage |
$120.63
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Central Health Plan Commercial |
$496.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.94
|
| Rate for Payer: Dignity Health Media |
$120.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$120.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.63
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$465.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$197.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$120.63
|
| Rate for Payer: InnovAge PACE Commercial |
$180.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.64
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Prime Health Services Medicare |
$127.87
|
| Rate for Payer: Riverside University Health System MISP |
$132.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.69
|
| Rate for Payer: Vantage Medical Group Senior |
$120.63
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Central Health Plan Commercial |
$496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,327.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.96
|
| Rate for Payer: Blue Distinction Transplant |
$300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.00
|
| Rate for Payer: Blue Shield of California EPN |
$243.00
|
| Rate for Payer: Caremore Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Media |
$185.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$375.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: InnovAge PACE Commercial |
$277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Riverside University Health System MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$126.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.35
|
| Rate for Payer: Blue Distinction Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 PHENOTYPE NOT RH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$741.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.93
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.72
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| 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 |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| 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: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$741.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: InnovAge PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Riverside University Health System MISP |
$494.02
|
| 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 |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 PHLEBOTOMY
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.00
|
| Rate for Payer: Blue Distinction Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Caremore Medicare Advantage |
$8.57
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$12.86
|
| Rate for Payer: Dignity Health Media |
$8.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.57
|
| 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: Health Plan of Nevada (Sierra) Other |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.57
|
| Rate for Payer: InnovAge PACE Commercial |
$12.86
|
| 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 |
$8.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.48
|
| 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: Prime Health Services Medicare |
$9.08
|
| Rate for Payer: Riverside University Health System MISP |
$9.43
|
| 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 |
$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: Vantage Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.57
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$90.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$556.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Blue Distinction Transplant |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$27.05
|
| Rate for Payer: Blue Shield of California EPN |
$21.03
|
| Rate for Payer: Caremore Medicare Advantage |
$90.68
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.02
|
| Rate for Payer: Dignity Health Media |
$90.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$90.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.68
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.68
|
| Rate for Payer: InnovAge PACE Commercial |
$136.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$96.12
|
| Rate for Payer: Riverside University Health System MISP |
$99.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.75
|
| Rate for Payer: Vantage Medical Group Senior |
$90.68
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$95.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Blue Distinction Transplant |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$27.05
|
| Rate for Payer: Blue Shield of California EPN |
$21.03
|
| Rate for Payer: Caremore Medicare Advantage |
$95.16
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.74
|
| Rate for Payer: Dignity Health Media |
$95.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$95.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$95.16
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$156.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$157.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$95.16
|
| Rate for Payer: InnovAge PACE Commercial |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.51
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$100.87
|
| Rate for Payer: Riverside University Health System MISP |
$104.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.68
|
| Rate for Payer: Vantage Medical Group Senior |
$95.16
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.56
|
| 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 |
$138.30
|
| Rate for Payer: Blue Distinction Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$185.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Caremore Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.56
|
| Rate for Payer: Dignity Health Media |
$18.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: InnovAge PACE Commercial |
$27.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| 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 |
$60.00
|
| 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 |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| 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 |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.32
|
| Rate for Payer: Blue Distinction Transplant |
$240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$251.60
|
| Rate for Payer: Blue Shield of California EPN |
$195.60
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$300.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: InnovAge PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$2,006.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$619.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.36
|
| Rate for Payer: Blue Distinction Transplant |
$289.80
|
| Rate for Payer: Blue Shield of California Commercial |
$303.81
|
| Rate for Payer: Blue Shield of California EPN |
$236.19
|
| Rate for Payer: Caremore Medicare Advantage |
$619.39
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.08
|
| Rate for Payer: Dignity Health Media |
$619.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$619.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$619.39
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$362.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,015.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,021.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$619.39
|
| Rate for Payer: InnovAge PACE Commercial |
$929.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$619.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$829.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.98
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$656.55
|
| Rate for Payer: Riverside University Health System MISP |
$681.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Vantage Medical Group Senior |
$619.39
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$2,006.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$619.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.72
|
| Rate for Payer: Blue Distinction Transplant |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$320.16
|
| Rate for Payer: Blue Shield of California EPN |
$248.90
|
| Rate for Payer: Caremore Medicare Advantage |
$619.39
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| 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 |
$929.08
|
| Rate for Payer: Dignity Health Media |
$619.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$619.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$619.39
|
| 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: Health Plan of Nevada (Sierra) Other |
$381.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,015.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,021.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$619.39
|
| Rate for Payer: InnovAge PACE Commercial |
$929.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$619.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$829.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.98
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$656.55
|
| Rate for Payer: Riverside University Health System MISP |
$681.33
|
| 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 |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Vantage Medical Group Senior |
$619.39
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Central Health Plan Commercial |
$407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$2,006.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$619.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.18
|
| Rate for Payer: Blue Distinction Transplant |
$275.40
|
| Rate for Payer: Blue Shield of California Commercial |
$288.71
|
| Rate for Payer: Blue Shield of California EPN |
$224.45
|
| Rate for Payer: Caremore Medicare Advantage |
$619.39
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Central Health Plan Commercial |
$367.20
|
| Rate for Payer: Cigna of CA HMO |
$293.76
|
| Rate for Payer: Cigna of CA PPO |
$339.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.08
|
| Rate for Payer: Dignity Health Media |
$619.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$619.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$619.39
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$413.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$344.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,015.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,021.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$619.39
|
| Rate for Payer: InnovAge PACE Commercial |
$929.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$619.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$829.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$829.98
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Prime Health Services Medicare |
$656.55
|
| Rate for Payer: Riverside University Health System MISP |
$681.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.33
|
| Rate for Payer: Vantage Medical Group Senior |
$619.39
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Central Health Plan Commercial |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$413.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.80
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Central Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$581.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.20
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
