|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$5,132.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$722.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,132.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,084.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$312.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.66
|
| Rate for Payer: Blue Distinction Transplant |
$387.60
|
| Rate for Payer: Blue Shield of California Commercial |
$406.33
|
| Rate for Payer: Blue Shield of California EPN |
$315.89
|
| Rate for Payer: Caremore Medicare Advantage |
$722.92
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Central Health Plan Commercial |
$516.80
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.38
|
| Rate for Payer: Dignity Health Media |
$722.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$722.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$722.92
|
| 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: Health Plan of Nevada (Sierra) Other |
$484.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,185.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,192.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$722.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,084.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$722.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$968.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$968.71
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$766.30
|
| Rate for Payer: Riverside University Health System MISP |
$795.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| 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 |
$1,084.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: Vantage Medical Group Senior |
$722.92
|
|
|
HC SBBB PLATELETS APH/LEUOK PRT LOW YLD
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$119.20 |
| Max. Negotiated Rate |
$536.40 |
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Central Health Plan Commercial |
$476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.40
|
| Rate for Payer: Galaxy Health WC |
$506.60
|
| Rate for Payer: Global Benefits Group Commercial |
$357.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$536.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.20
|
| Rate for Payer: Multiplan Commercial |
$447.00
|
| Rate for Payer: Networks By Design Commercial |
$387.40
|
| Rate for Payer: Prime Health Services Commercial |
$506.60
|
|
|
HC SBBB PLATELETS APH/LEUOK PRT LOW YLD
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$119.20 |
| Max. Negotiated Rate |
$5,132.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$722.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,132.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,084.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$288.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.12
|
| Rate for Payer: Blue Distinction Transplant |
$357.60
|
| Rate for Payer: Blue Shield of California Commercial |
$374.88
|
| Rate for Payer: Blue Shield of California EPN |
$291.44
|
| Rate for Payer: Caremore Medicare Advantage |
$722.92
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Central Health Plan Commercial |
$476.80
|
| Rate for Payer: Cigna of CA HMO |
$381.44
|
| Rate for Payer: Cigna of CA PPO |
$441.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.38
|
| Rate for Payer: Dignity Health Media |
$722.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$722.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$722.92
|
| Rate for Payer: Galaxy Health WC |
$506.60
|
| Rate for Payer: Global Benefits Group Commercial |
$357.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$536.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$447.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,185.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,192.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$722.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,084.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$397.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$722.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$968.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$968.71
|
| Rate for Payer: Multiplan Commercial |
$447.00
|
| Rate for Payer: Networks By Design Commercial |
$387.40
|
| Rate for Payer: Prime Health Services Commercial |
$506.60
|
| Rate for Payer: Prime Health Services Medicare |
$766.30
|
| Rate for Payer: Riverside University Health System MISP |
$795.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$357.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$357.60
|
| 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 |
$1,084.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.21
|
| Rate for Payer: Vantage Medical Group Senior |
$722.92
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.12
|
| 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 |
$27.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.68
|
| Rate for Payer: Blue Distinction Transplant |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$35.23
|
| Rate for Payer: Blue Shield of California EPN |
$27.70
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| 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 |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.75
|
| 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 |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| 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 |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| 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 |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.05
|
| Rate for Payer: United Healthcare All Other HMO |
$46.05
|
| Rate for Payer: United Healthcare HMO Rider |
$46.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.05
|
| Rate for Payer: 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 POOLING OF COMPONENTS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| 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 POOLING OF COMPONENTS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.22
|
| 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 |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: Blue Distinction Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$62.90
|
| Rate for Payer: Blue Shield of California EPN |
$48.90
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$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 |
$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 |
$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 |
$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 |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| 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 |
$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 |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| 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 |
$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 PRE TREAT PANEL W ENZYMES
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
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 PRE TREAT PANEL W ENZYMES
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$352.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.86
|
| 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 |
$104.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.78
|
| 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 |
$213.41
|
| 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 |
$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 |
$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 |
$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 |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| 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 |
$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 |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| 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 |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: 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 PRE TREAT RBC CHEMICAL RE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
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 PRE TREAT RBC CHEMICAL RE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$127.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.81
|
| 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 |
$104.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.78
|
| 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 |
$76.42
|
| 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 |
$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 |
$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 |
$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 |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| 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 |
$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 |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| 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 |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: 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 RBC LEUKOREDUCED
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Central Health Plan Commercial |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.20
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$1,302.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$237.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,302.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.61
|
| Rate for Payer: Blue Distinction Transplant |
$142.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.70
|
| Rate for Payer: Blue Shield of California EPN |
$116.38
|
| Rate for Payer: Caremore Medicare Advantage |
$237.12
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Central Health Plan Commercial |
$190.40
|
| Rate for Payer: Cigna of CA HMO |
$152.32
|
| Rate for Payer: Cigna of CA PPO |
$176.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.68
|
| Rate for Payer: Dignity Health Media |
$237.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$237.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.12
|
| Rate for Payer: Galaxy Health WC |
$202.30
|
| Rate for Payer: Global Benefits Group Commercial |
$142.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$178.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$388.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$237.12
|
| Rate for Payer: InnovAge PACE Commercial |
$355.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.74
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: Networks By Design Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Commercial |
$202.30
|
| Rate for Payer: Prime Health Services Medicare |
$251.35
|
| Rate for Payer: Riverside University Health System MISP |
$260.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.80
|
| 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 |
$355.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.83
|
| Rate for Payer: Vantage Medical Group Senior |
$237.12
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.76
|
| Rate for Payer: Blue Distinction Transplant |
$342.00
|
| Rate for Payer: Blue Shield of California Commercial |
$358.53
|
| Rate for Payer: Blue Shield of California EPN |
$278.73
|
| Rate for Payer: Caremore Medicare Advantage |
$195.48
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$364.80
|
| Rate for Payer: Cigna of CA PPO |
$421.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Media |
$195.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.48
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: InnovAge PACE Commercial |
$293.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.94
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Prime Health Services Medicare |
$207.21
|
| Rate for Payer: Riverside University Health System MISP |
$215.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 WHOLE UNIT
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900909508
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$1,302.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$237.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,302.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.91
|
| Rate for Payer: Blue Distinction Transplant |
$267.00
|
| Rate for Payer: Blue Shield of California Commercial |
$279.90
|
| Rate for Payer: Blue Shield of California EPN |
$217.60
|
| Rate for Payer: Caremore Medicare Advantage |
$237.12
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.68
|
| Rate for Payer: Dignity Health Media |
$237.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$237.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.12
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$333.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$388.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$237.12
|
| Rate for Payer: InnovAge PACE Commercial |
$355.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.74
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Prime Health Services Medicare |
$251.35
|
| Rate for Payer: Riverside University Health System MISP |
$260.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| 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 |
$355.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.83
|
| Rate for Payer: Vantage Medical Group Senior |
$237.12
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 WHOLE UNIT
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900909508
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC SBBB RBC OCTOPED CMV LEUKOREDU
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904705
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$1,302.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$237.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,302.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.45
|
| Rate for Payer: Blue Distinction Transplant |
$270.60
|
| Rate for Payer: Blue Shield of California Commercial |
$283.68
|
| Rate for Payer: Blue Shield of California EPN |
$220.54
|
| Rate for Payer: Caremore Medicare Advantage |
$237.12
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: Cigna of CA HMO |
$288.64
|
| Rate for Payer: Cigna of CA PPO |
$333.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.68
|
| Rate for Payer: Dignity Health Media |
$237.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$237.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$237.12
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$338.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$388.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$237.12
|
| Rate for Payer: InnovAge PACE Commercial |
$355.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.74
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
| Rate for Payer: Prime Health Services Medicare |
$251.35
|
| Rate for Payer: Riverside University Health System MISP |
$260.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.60
|
| 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 |
$355.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.83
|
| Rate for Payer: Vantage Medical Group Senior |
$237.12
|
|
|
HC SBBB RBC OCTOPED CMV LEUKOREDU
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904705
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$405.90 |
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Central Health Plan Commercial |
$360.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.40
|
| Rate for Payer: Galaxy Health WC |
$383.35
|
| Rate for Payer: Global Benefits Group Commercial |
$270.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: Networks By Design Commercial |
$293.15
|
| Rate for Payer: Prime Health Services Commercial |
$383.35
|
|
|
HC SBBB RETIC SEPARATION
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
900904737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$352.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.74
|
| 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 |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.69
|
| Rate for Payer: Blue Distinction Transplant |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.35
|
| Rate for Payer: Blue Shield of California EPN |
$36.45
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| 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 |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$56.25
|
| 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 |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| 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 |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| 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 |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: 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 RETIC SEPARATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
900904737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SBBB RH D TYPING
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.92
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC SBBB RH D TYPING
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SBBB RH PHENOTYPING
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
900904623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.76
|
| Rate for Payer: Blue Distinction Transplant |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.35
|
| Rate for Payer: Blue Shield of California EPN |
$36.45
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.28
|
| Rate for Payer: United Healthcare All Other HMO |
$6.28
|
| Rate for Payer: United Healthcare HMO Rider |
$6.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC SBBB RH PHENOTYPING
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
900904623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
