|
HC SBBB DD ADMIN FEE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
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 DEGLYC RBC LEUKO
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$500.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.76
|
| Rate for Payer: Blue Shield of California Commercial |
$366.61
|
| Rate for Payer: Blue Shield of California EPN |
$293.29
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$390.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$500.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$333.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$333.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.02
|
| Rate for Payer: Heritage Provider Network Senior |
$372.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$333.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$286.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$447.36
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$367.24
|
| Rate for Payer: TriValley Medical Group Senior |
$333.85
|
| 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 |
$500.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.24
|
| Rate for Payer: Vantage Medical Group Senior |
$333.85
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$450.75 |
| Rate for Payer: Adventist Health Commercial |
$120.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$387.04
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.88
|
| Rate for Payer: Heritage Provider Network Senior |
$406.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.25
|
| Rate for Payer: Multiplan Commercial |
$450.75
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$798.18 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.12
|
| Rate for Payer: Blue Shield of California Commercial |
$537.41
|
| Rate for Payer: Blue Shield of California EPN |
$429.93
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$532.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$519.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$532.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$532.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$420.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$713.04
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$585.33
|
| Rate for Payer: TriValley Medical Group Senior |
$532.12
|
| 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 |
$798.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.33
|
| Rate for Payer: Vantage Medical Group Senior |
$532.12
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.36
|
| Rate for Payer: Cash Price |
$881.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.86
|
| Rate for Payer: Blue Shield of California Commercial |
$105.02
|
| Rate for Payer: Blue Shield of California EPN |
$84.46
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.87
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC SBBB DILUTION
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.54
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SBBB DILUTION
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$136.73 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| 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 |
$136.73
|
| Rate for Payer: Blue Shield of California Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California EPN |
$30.88
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| 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 |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| 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 ELUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.06
|
| 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 |
$256.33
|
| Rate for Payer: Blue Shield of California Commercial |
$94.94
|
| Rate for Payer: Blue Shield of California EPN |
$76.35
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.65
|
| 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 |
$52.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.14
|
| Rate for Payer: Heritage Provider Network Senior |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| 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 |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SBBB ELUTION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.16
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.84
|
| Rate for Payer: Heritage Provider Network Senior |
$54.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
|
|
HC SBBB FFP APHERESIS TO 499 ML
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.97
|
| 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 |
$273.69
|
| Rate for Payer: Blue Shield of California Commercial |
$297.07
|
| Rate for Payer: Blue Shield of California EPN |
$237.66
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$316.55
|
| 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 |
$287.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.45
|
| Rate for Payer: Heritage Provider Network Senior |
$301.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$232.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.45
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| 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 FFP APHERESIS TO 499 ML
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.63
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.70
|
| Rate for Payer: Heritage Provider Network Senior |
$329.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
|
|
HC SBBB FFP PED PAK ALIQUOT
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$455.95
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$479.32
|
| Rate for Payer: Heritage Provider Network Senior |
$479.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
|
|
HC SBBB FFP PED PAK ALIQUOT
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904530
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$437.54
|
| 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 |
$397.90
|
| Rate for Payer: Blue Shield of California Commercial |
$431.88
|
| Rate for Payer: Blue Shield of California EPN |
$345.50
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$460.20
|
| 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 |
$417.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$438.25
|
| Rate for Payer: Heritage Provider Network Senior |
$438.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$337.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
| 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 FFP PEDS
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Adventist Health Commercial |
$84.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.77
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.69
|
| Rate for Payer: Heritage Provider Network Senior |
$285.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.50
|
| Rate for Payer: Multiplan Commercial |
$316.50
|
|
|
HC SBBB FFP PEDS
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$84.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.80
|
| 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 |
$237.16
|
| Rate for Payer: Blue Shield of California Commercial |
$257.42
|
| Rate for Payer: Blue Shield of California EPN |
$205.94
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cash Price |
$422.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.30
|
| 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 |
$248.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.22
|
| Rate for Payer: Heritage Provider Network Senior |
$261.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$201.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$316.50
|
| 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 FFP SPLIT UNIT GT 150 ML
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$177.56 |
| Max. Negotiated Rate |
$735.75 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$606.26
|
| 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 |
$551.32
|
| Rate for Payer: Blue Shield of California Commercial |
$598.41
|
| Rate for Payer: Blue Shield of California EPN |
$478.73
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$637.65
|
| 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 |
$578.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$607.24
|
| Rate for Payer: Heritage Provider Network Senior |
$607.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$467.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
| 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 FFP SPLIT UNIT GT 150 ML
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904533
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$177.56 |
| Max. Negotiated Rate |
$735.75 |
| Rate for Payer: Adventist Health Commercial |
$196.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$631.76
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.14
|
| Rate for Payer: Heritage Provider Network Senior |
$664.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.25
|
| Rate for Payer: Multiplan Commercial |
$735.75
|
|
|
HC SBBB FFP TO 399 ML
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.94
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.59
|
| Rate for Payer: Heritage Provider Network Senior |
$300.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
|
|
HC SBBB FFP TO 399 ML
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.39
|
| 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 |
$249.53
|
| Rate for Payer: Blue Shield of California Commercial |
$270.84
|
| Rate for Payer: Blue Shield of California EPN |
$216.67
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$288.60
|
| 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 |
$261.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.84
|
| Rate for Payer: Heritage Provider Network Senior |
$274.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$211.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.45
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| 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 FREEZE & DEGLYC PROC
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.68
|
| Rate for Payer: Blue Shield of California Commercial |
$159.21
|
| Rate for Payer: Blue Shield of California EPN |
$127.37
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.56
|
| Rate for Payer: Heritage Provider Network Senior |
$161.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$124.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.84
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| 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 |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC SBBB FREEZE & DEGLYC PROC
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.08
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.70
|
| Rate for Payer: Heritage Provider Network Senior |
$176.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
IP
|
$5,307.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$960.57 |
| Max. Negotiated Rate |
$3,980.25 |
| Rate for Payer: Adventist Health Commercial |
$1,061.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,417.71
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,592.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,592.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$960.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.75
|
| Rate for Payer: Multiplan Commercial |
$3,980.25
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
OP
|
$5,307.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$526.00 |
| Max. Negotiated Rate |
$4,510.95 |
| Rate for Payer: Adventist Health Commercial |
$1,061.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,510.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,918.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,980.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,982.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,237.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,589.82
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Cash Price |
$5,307.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,449.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,510.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,510.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,510.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,131.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,285.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3,285.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,531.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$960.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,714.90
|
| Rate for Payer: Multiplan Commercial |
$3,980.25
|
| 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 |
$4,510.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,510.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,510.95
|
|
