|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$50.52 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.52
|
| Rate for Payer: Blue Shield of California Commercial |
$44.41
|
| Rate for Payer: Blue Shield of California EPN |
$35.62
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Senior |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.51
|
| Rate for Payer: TriValley Medical Group Senior |
$5.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.24
|
| Rate for Payer: Heritage Provider Network Senior |
$234.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$184.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.32
|
| Rate for Payer: Blue Shield of California Commercial |
$211.06
|
| Rate for Payer: Blue Shield of California EPN |
$168.85
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Senior |
$58.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.17
|
| Rate for Payer: Heritage Provider Network Senior |
$214.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$165.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.08
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$63.80
|
| Rate for Payer: TriValley Medical Group Senior |
$58.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$760.53 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.47
|
| Rate for Payer: Blue Shield of California Commercial |
$48.48
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$216.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.13
|
| Rate for Payer: Heritage Provider Network Senior |
$206.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$507.02
|
| Rate for Payer: TriValley Medical Group Senior |
$507.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$299.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$249.75 |
| Rate for Payer: Adventist Health Commercial |
$66.60
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.44
|
| Rate for Payer: Heritage Provider Network Senior |
$225.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$249.75
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.15
|
| Rate for Payer: Heritage Provider Network Senior |
$75.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.47
|
| Rate for Payer: Blue Shield of California Commercial |
$48.48
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.71
|
| Rate for Payer: Heritage Provider Network Senior |
$68.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB IRRADIATION
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.24
|
| Rate for Payer: Blue Shield of California Commercial |
$29.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$54.86
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC SBBB IRRADIATION
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.87
|
| Rate for Payer: Heritage Provider Network Senior |
$100.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.54
|
| Rate for Payer: Blue Shield of California Commercial |
$90.89
|
| Rate for Payer: Blue Shield of California EPN |
$72.71
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.39
|
| Rate for Payer: Dignity Health Senior |
$62.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.23
|
| Rate for Payer: Heritage Provider Network Senior |
$92.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.33
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$68.39
|
| Rate for Payer: TriValley Medical Group Senior |
$62.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.39
|
| Rate for Payer: Vantage Medical Group Senior |
$62.17
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$374.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$481.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$314.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.75
|
| Rate for Payer: Blue Shield of California Commercial |
$427.61
|
| Rate for Payer: Blue Shield of California EPN |
$342.09
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$455.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.64
|
| Rate for Payer: Dignity Health Senior |
$286.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$286.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.92
|
| Rate for Payer: Heritage Provider Network Senior |
$433.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$412.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$286.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$334.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$328.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$360.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$360.41
|
| Rate for Payer: Multiplan Commercial |
$525.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$314.64
|
| Rate for Payer: TriValley Medical Group Senior |
$286.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.64
|
| Rate for Payer: Vantage Medical Group Senior |
$286.04
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$525.75 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$474.58
|
| Rate for Payer: Heritage Provider Network Senior |
$474.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.25
|
| Rate for Payer: Multiplan Commercial |
$525.75
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$374.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$481.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.75
|
| Rate for Payer: Blue Shield of California Commercial |
$427.61
|
| Rate for Payer: Blue Shield of California EPN |
$342.09
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$455.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.64
|
| Rate for Payer: Dignity Health Senior |
$106.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$106.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.92
|
| Rate for Payer: Heritage Provider Network Senior |
$433.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$334.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.76
|
| Rate for Payer: Multiplan Commercial |
$525.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$117.64
|
| Rate for Payer: TriValley Medical Group Senior |
$106.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.64
|
| Rate for Payer: Vantage Medical Group Senior |
$106.95
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$525.75 |
| Rate for Payer: Adventist Health Commercial |
$140.20
|
| Rate for Payer: Cash Price |
$701.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$474.58
|
| Rate for Payer: Heritage Provider Network Senior |
$474.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.25
|
| Rate for Payer: Multiplan Commercial |
$525.75
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Adventist Health Commercial |
$111.20
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.41
|
| Rate for Payer: Heritage Provider Network Senior |
$376.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$417.00
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$1,366.26 |
| Rate for Payer: Adventist Health Commercial |
$111.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$297.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.97
|
| 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 HMO/PPO |
$1,366.26
|
| Rate for Payer: Blue Shield of California Commercial |
$339.16
|
| Rate for Payer: Blue Shield of California EPN |
$271.33
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cash Price |
$556.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$361.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.16
|
| Rate for Payer: Heritage Provider Network Senior |
$344.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$265.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| 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 PATIENT SERUM SCREEN
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.97
|
| Rate for Payer: Heritage Provider Network Senior |
$41.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$113.20 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.79
|
| Rate for Payer: Blue Shield of California Commercial |
$76.49
|
| Rate for Payer: Blue Shield of California EPN |
$61.35
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.47
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$685.59 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.91
|
| Rate for Payer: Blue Shield of California Commercial |
$30.76
|
| Rate for Payer: Blue Shield of California EPN |
$24.67
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.09
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Senior |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.09
|
| Rate for Payer: TriValley Medical Group Senior |
$9.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9.09
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SBBB PHONE ORDER
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
