|
HC SBBB ANTIGEN SCREENING CLASS I
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904574
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SBBB ANTIGEN SCREENING CLASS I
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904574
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.15
|
| Rate for Payer: Blue Shield of California Commercial |
$45.75
|
| Rate for Payer: Blue Shield of California EPN |
$36.60
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.99
|
| Rate for Payer: TriValley Medical Group Senior |
$6.35
|
| 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 |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING CLASS II
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904769
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.65
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
|
|
HC SBBB ANTIGEN SCREENING CLASS II
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904769
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.75
|
| Rate for Payer: Blue Shield of California Commercial |
$81.13
|
| Rate for Payer: Blue Shield of California EPN |
$64.90
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.33
|
| Rate for Payer: Heritage Provider Network Senior |
$82.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.99
|
| Rate for Payer: TriValley Medical Group Senior |
$6.35
|
| 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 |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING RARE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904770
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.59
|
| Rate for Payer: Blue Shield of California Commercial |
$118.95
|
| Rate for Payer: Blue Shield of California EPN |
$95.16
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.99
|
| Rate for Payer: TriValley Medical Group Senior |
$6.35
|
| 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 |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING RARE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904770
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$125.58
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC SBBB AUTO ADMIN FEE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.46
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC SBBB AUTO ADMIN FEE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.03
|
| Rate for Payer: Blue Shield of California Commercial |
$95.16
|
| Rate for Payer: Blue Shield of California EPN |
$76.13
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC SBBB COLD AGGLUTININ SCREEN
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.09
|
| Rate for Payer: Blue Shield of California Commercial |
$53.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.24
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.07
|
| Rate for Payer: TriValley Medical Group Senior |
$8.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
HC SBBB COLD AGGLUTININ SCREEN
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.89
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC SBBB CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$1,017.00 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.07
|
| Rate for Payer: Blue Shield of California Commercial |
$827.16
|
| Rate for Payer: Blue Shield of California EPN |
$661.73
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$881.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.36
|
| Rate for Payer: Heritage Provider Network Senior |
$839.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$646.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.45
|
| Rate for Payer: Multiplan Commercial |
$1,017.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$102.16
|
| Rate for Payer: TriValley Medical Group Senior |
$92.87
|
| 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 |
$139.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.16
|
| Rate for Payer: Vantage Medical Group Senior |
$92.87
|
|
|
HC SBBB CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,017.00 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.26
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.01
|
| Rate for Payer: Heritage Provider Network Senior |
$918.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,017.00
|
|
|
HC SBBB COOMBS DIRECT EA ANTISERA
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.81
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC SBBB COOMBS DIRECT EA ANTISERA
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$51.01 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.01
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SBBB COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$1,284.13 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$915.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,284.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$941.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$856.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.88
|
| Rate for Payer: Blue Shield of California Commercial |
$904.02
|
| Rate for Payer: Blue Shield of California EPN |
$723.22
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$963.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,284.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$941.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$856.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$856.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$917.36
|
| Rate for Payer: Heritage Provider Network Senior |
$917.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$856.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$706.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$984.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,147.16
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$941.70
|
| Rate for Payer: TriValley Medical Group Senior |
$856.09
|
| 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 |
$1,284.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$941.70
|
| Rate for Payer: Vantage Medical Group Senior |
$856.09
|
|
|
HC SBBB COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,482.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$1,111.50 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$954.41
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,003.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,003.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
|
|
HC SBBB COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.19 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.13
|
| Rate for Payer: Blue Shield of California Commercial |
$675.27
|
| Rate for Payer: Blue Shield of California EPN |
$540.22
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$719.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.23
|
| Rate for Payer: Heritage Provider Network Senior |
$685.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$528.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$215.81
|
| Rate for Payer: TriValley Medical Group Senior |
$196.19
|
| 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 |
$294.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.81
|
| Rate for Payer: Vantage Medical Group Senior |
$196.19
|
|
|
HC SBBB COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$200.37 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.91
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.44
|
| Rate for Payer: Heritage Provider Network Senior |
$749.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.75
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
|
|
HC SBBB CROSSMATCH PER UNIT
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904714
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.58
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.07
|
| Rate for Payer: Heritage Provider Network Senior |
$92.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
|
|
HC SBBB CROSSMATCH PER UNIT
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904714
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.43
|
| Rate for Payer: Blue Shield of California Commercial |
$82.96
|
| Rate for Payer: Blue Shield of California EPN |
$66.37
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$241.03
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| 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 |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SBBB CRYOPRECIPITATE
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904563
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.06
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.05
|
| Rate for Payer: Heritage Provider Network Senior |
$287.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.00
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
|
|
HC SBBB CRYOPRECIPITATE
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904563
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$262.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.29
|
| Rate for Payer: Blue Shield of California Commercial |
$258.64
|
| Rate for Payer: Blue Shield of California EPN |
$206.91
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$275.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.46
|
| Rate for Payer: Heritage Provider Network Senior |
$262.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$202.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.64
|
| Rate for Payer: TriValley Medical Group Senior |
$90.58
|
| 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 |
$135.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Vantage Medical Group Senior |
$90.58
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.32
|
| Rate for Payer: Blue Shield of California Commercial |
$71.98
|
| Rate for Payer: Blue Shield of California EPN |
$57.58
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.38
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.64
|
| Rate for Payer: TriValley Medical Group Senior |
$90.58
|
| 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 |
$135.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.64
|
| Rate for Payer: Vantage Medical Group Senior |
$90.58
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.99
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC SBBB DD ADMIN FEE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.46
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
