|
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: Aetna of CA Non-Gatekeeper |
$16.10
|
| 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 Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SBBB PLASMA CRYO POOR
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
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 PLASMA CRYO POOR
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT P9044
|
| Hospital Charge Code |
900904725
|
|
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 |
$249.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.24
|
| 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 |
$249.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$166.24
|
| 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 |
$166.24
|
| 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 |
$191.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$222.76
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.86
|
| Rate for Payer: TriValley Medical Group Senior |
$166.24
|
| 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 |
$249.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.86
|
| Rate for Payer: Vantage Medical Group Senior |
$166.24
|
|
|
HC SBBB PLASMA FROZEN
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
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 PLASMA FROZEN
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904560
|
|
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 PLATELET ANTIBODY SCREEN
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.98
|
| Rate for Payer: Blue Shield of California Commercial |
$147.80
|
| Rate for Payer: Blue Shield of California EPN |
$118.55
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.56
|
| Rate for Payer: Heritage Provider Network Senior |
$213.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$164.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SBBB PLATELET ANTIBODY SCREEN
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900904602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.18
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.56
|
| Rate for Payer: Heritage Provider Network Senior |
$233.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.24
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.42
|
| Rate for Payer: Heritage Provider Network Senior |
$311.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
|
|
HC SBBB PLATELET APHERESIS CROSSM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904426
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.28
|
| 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 |
$258.52
|
| Rate for Payer: Blue Shield of California Commercial |
$280.60
|
| Rate for Payer: Blue Shield of California EPN |
$224.48
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$299.00
|
| 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 |
$271.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.74
|
| Rate for Payer: Heritage Provider Network Senior |
$284.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$219.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| 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 PLATELET PED PAK ALIQUOT
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$616.15
|
| 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 |
$560.31
|
| Rate for Payer: Blue Shield of California Commercial |
$608.17
|
| Rate for Payer: Blue Shield of California EPN |
$486.54
|
| Rate for Payer: Cash Price |
$997.00
|
| Rate for Payer: Cash Price |
$997.00
|
| Rate for Payer: Cash Price |
$997.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$648.05
|
| 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 |
$588.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$617.14
|
| Rate for Payer: Heritage Provider Network Senior |
$617.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$475.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| 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 PLATELET PED PAK ALIQUOT
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$642.07
|
| Rate for Payer: Cash Price |
$997.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.97
|
| Rate for Payer: Heritage Provider Network Senior |
$674.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$180.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$966.06 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.97
|
| Rate for Payer: Blue Shield of California Commercial |
$344.04
|
| Rate for Payer: Blue Shield of California EPN |
$275.23
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$366.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$644.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.12
|
| Rate for Payer: Heritage Provider Network Senior |
$349.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$644.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$269.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$740.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.01
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$708.44
|
| Rate for Payer: TriValley Medical Group Senior |
$644.04
|
| 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 |
$966.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Vantage Medical Group Senior |
$644.04
|
|
|
HC SBBB PLATELETS APHERESIS/LEUKO
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904503
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$112.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.22
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.83
|
| Rate for Payer: Heritage Provider Network Senior |
$381.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$413.45
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$434.63
|
| Rate for Payer: Heritage Provider Network Senior |
$434.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.50
|
| Rate for Payer: Multiplan Commercial |
$481.50
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904755
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$966.06 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.80
|
| Rate for Payer: Blue Shield of California Commercial |
$391.62
|
| Rate for Payer: Blue Shield of California EPN |
$313.30
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$417.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$644.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$397.40
|
| Rate for Payer: Heritage Provider Network Senior |
$397.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$644.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$306.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$740.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.01
|
| Rate for Payer: Multiplan Commercial |
$481.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$708.44
|
| Rate for Payer: TriValley Medical Group Senior |
$644.04
|
| 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 |
$966.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Vantage Medical Group Senior |
$644.04
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$966.06 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.70
|
| Rate for Payer: Blue Shield of California Commercial |
$361.12
|
| Rate for Payer: Blue Shield of California EPN |
$288.90
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$644.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.45
|
| Rate for Payer: Heritage Provider Network Senior |
$366.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$644.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$282.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$740.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.01
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$708.44
|
| Rate for Payer: TriValley Medical Group Senior |
$644.04
|
| 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 |
$966.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.44
|
| Rate for Payer: Vantage Medical Group Senior |
$644.04
|
|
|
HC SBBB PLATELETS APH/LEUKO LVDS LOW YLD
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
900904757
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.25
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$1,147.04 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$489.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.10
|
| Rate for Payer: Blue Shield of California Commercial |
$483.12
|
| Rate for Payer: Blue Shield of California EPN |
$386.50
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$514.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$841.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$764.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$467.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$764.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$490.25
|
| Rate for Payer: Heritage Provider Network Senior |
$490.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$764.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$377.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$879.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,024.68
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$841.16
|
| Rate for Payer: TriValley Medical Group Senior |
$764.69
|
| 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 |
$1,147.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Vantage Medical Group Senior |
$764.69
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904754
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$510.05
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.18
|
| Rate for Payer: Heritage Provider Network Senior |
$536.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.85
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC SBBB PLATELETS APH/LEUKO PRT LOW YLD
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
900904756
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$1,147.04 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.00
|
| Rate for Payer: Blue Shield of California Commercial |
$452.62
|
| Rate for Payer: Blue Shield of California EPN |
$362.10
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$841.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$764.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$764.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.30
|
| Rate for Payer: Heritage Provider Network Senior |
$459.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$764.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$879.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,024.68
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$841.16
|
| Rate for Payer: TriValley Medical Group Senior |
$764.69
|
| 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 |
$1,147.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$841.16
|
| Rate for Payer: Vantage Medical Group Senior |
$764.69
|
|
|
HC SBBB PLT PATHOGEN TESTING
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$113.81 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.70
|
| 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 |
$30.51
|
| Rate for Payer: Blue Shield of California Commercial |
$37.21
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.65
|
| 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 |
$39.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.76
|
| Rate for Payer: Heritage Provider Network Senior |
$37.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| 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 |
$61.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.40
|
| 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 PLT PATHOGEN TESTING
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT P9100
|
| Hospital Charge Code |
900905002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.28
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.30
|
| Rate for Payer: Heritage Provider Network Senior |
$41.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
|
|
HC SBBB POOLING OF COMPONENTS
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.78
|
| 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 |
$68.00
|
| Rate for Payer: Blue Shield of California Commercial |
$73.81
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| 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 |
$71.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| 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 POOLING OF COMPONENTS
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904607
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.92
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
